Dr. Dary Samimi, M.D., F.A.C.O.G.
     Pioneer of Techniques in Nerve Sparing Gynecologic Urogynecologic Surgery

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Dr. Samimi has several Lectures that are available.
Burch-Sling Lecture
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Vaginal prolapse Lecture:
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The Burch-Sling lecture will cover all the following aspects:

Daryoosh Samimi, M.D., FACOG
U.S. WOMEN INSTITUTE

BACKGROUND:
This is a report of a new technique and experience performing Outpatient Burch-Sling with No Laparotomy or Laparoscopy as a Nerve Sparing Technique.
The purpose of this operation is to describe the surgical approach to genuine stress urinary incontinence, which hopefully will prevent injuries to somatic nerve fibers:
  • External urethral sphincter nerve
  • Dorsal nerve of clitoris
  • Posterior nerve of labia majora
  • Posterior nerve of labia minora, plus
  • Vaginal nerves from autononilc nerve division

TECHNIQUE:
The procedure is a retropubic bladder neck suspension using our newly invented bladder saver device. In this technique, the vagina is elevated bilaterally at the urethrovesical junction. This repositions the proximal urethra within the abdominal cavity toward Cooper’s Ligament with permanent sutures. In this method the vaginal wall is used as an endogenous suburethral sling.

EXPERIENCE:
Fifty eight cases have been performed with no major complications and only one who bad no improvement. Follow-up is from six months to eight years. This minimally invasive outpatient closed Burch-Sling Procedure, utilizing the bladder saver device, allows performance of a time-proven operation with very little morbidity.

CONCLUSION:
There are many references in the medical literature relating to nerve injury due to surgery. The likelihood of damage is greater during traditional incontinence procedures because of extensive vaginal wall dissection. The unique features of our technique are:

1. May be done as an outpatient.
2. Absence of anterior vaginal wall dissection.
3. Use of an endogenous sling for colpo-urethiopexy.
4. Cooper’s Ligament is used to anchor the suspension sutures.


     The massive Vaginal Prolapse Lecture Will cover all these aspects:

Daryoosh Samimi, M.D., FACOG
U.S. WOMEN INSTITUTE
Fed. Registration No. 2032647


Objective:
Create a relatively bloodless, nerve-sparing support of the pelvis without hysterectomy.

METHOD:
Many patients with Grade 4 uterovaginal prolapse underwent a simple procedure wherein the endopelvic fascia cardinal uterosacral complex were raised up and anchored toward the ileopectineal line “ligament and tendinous sheet”. The uterus was preserved in each case.

RESULTS:
Postoperative pain was minimal and hospital stay was significantly shortened. massive uterovaginal prolapse is unacceptable to most who experience it.

CONCLUSION:
Quality of life was improved while sparing local nerve supply and preserving vaginal and uterine function. A device, invented by the author, facilitated the performance of the procedure and ensured correct placement of sutures. This technique can be mastered by any competent Surgeon and should become “State of the Art”

Hysterectomy: Short Stay Lecture
A Randomized Trial of Intrastromal Abdominal Hysterectomy To Support Shorter Hospital Stays and Prevent Blood Loss Without Disturbing the Pelvic Support.


The Intrastromal Abdominal Hysterectomy Lecture will cover all the following aspects:

A Randomized Trial of Intrastromal Abdominal Hysterectomy To Support Shorter Hospital Stays and Prevent Blood Loss Without Disturbing the Pelvic Support (abstract)

DARY SAMIMI, M.D.,ET. AL.
Fountain Valley Regional Hospital and Medical Center
Fountain Valley, California

OBJECTIVE:
To evaluate the effect of the new Intrastromal abdominal hysterectomy as a bloodless nerve-sparing method without disturbing the pelvic support system, versus the conventional abdominal hysterectomy. Additionally, to evaluate this method as an alternative procedure to prevent blood loss and enable a shorter hospital stay with fewer complications.

METHODS:
The hysterectomy can be performed using the following techniques — conventional, abdominal, vaginal, or laparoscopic assisted vaginal hysterectomy, intrafascial, extrafascial, and lastly the supracervical hysterectomy. The supracervical hysterectomy has been criticized in medical literature due to the number of patients developing cancer in the cervical stump that may lead to fatality. Moreover, it is important to acknowledge that the supercervical hysterectomy is expensive, which is to be attributed to the cost incurred as a result of the preventive measures considered for cancer.

The new intrastromal T.A.H. keeps the cardinal, utereosacral ligament, and vaginal apex unsevered. In the meantime, the entire cervix’s endocervical canal and the T-zone with uterus are removed, whereas the bed and the pericervical stroma remain. In the outer stroma of the cervix is a pericervical bed, and the cervix is removed from this bed.

A total of forty women were placed in this prospectively randomized clinical trial of the Intrastromal Abdominal Hysterectomy. Patients were randomized into two groups. In the study group (n=20), Intrastromal Abdominal Hysterectomy was performed from May 2000 — Sept 2001. In the control group (n=20), a conventional hysterectomy was performed, before April 2000.

RESULTS:
There were differences in the average blood loss ( hemoglobin 1.0 versus 1.4 g/dl, P0.00l ), and the average hospital stay (2.7 days versus 3.15 days, P=0.005) was in favor of the study group. There were no post-operation infections, ureter injuries, vaginal vault prolapses, and no post-hysterectomy fistula were seen.

CONCLUSION:
Intrastromal Abdominal Hysterectomy is a bloodless, nerve-sparing technique that does not disturb the pelvic support system. It also proves to be an effective alternative to the traditional hysterectomy, with advantages such as reduced blood loss, shorter hospital stay, and less frequent post-operation complications. Throughout this process, it is imperative that the patient’s fear cervical cancer should not be ignored.

• Dr. Samimi is a Diplomat, American Board of Gynecology (Obg), a member of the California Medical Association, The Orange County Medical Association (Ca)

• Dr. Samimi is a Gynecological Surgeon in several Hospitals in Southern Califormia.

• Inventor - Researcher - Discoverer in the field of: Gynecology - Urogynecology - Women health:
Dr. Samimi is a pioneer in nerve-sparing techniques in support of the pelvis.
He invented and holds the US Patent for the 'Bladder Saver Retropublic Ligature Carrier Device'

• Dr. Samimi is a progressive lecturer and in demand for his well known lecture on 'Outpatient Burch-Sling Procedure: A Nerve Sparing Method for Correction of Female Urinary Incontinence'. In addition he has published several Videos (DVD) of such procedures.

• Founder, Medical Director: US Woman Institute.
Dr. Samimi completed his residency at the major teaching Hospital at Case Western Reserve University in Cleveland, Ohio in 1978.

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