520: When NOT to Operate: Surgical Decision-Making in Complex Gynecologic Scenarios

Sunday, November 15, 2026
2:00 pm - 3:00 pm

Room: RM304

Chairs: Andreisa Paiva Monteiro Bilhar, Keith B. Isaacson

Faculty: Michel J. Canis, Mariana Vieira, Keith B. Isaacson

Description: Despite advances in minimally invasive gynecologic surgery, inappropriate or premature surgical intervention remains a major contributor to complications, inconsistent outcomes, and reduced patient autonomy. This panel discussion focuses on surgical decision-making in complex gynecologic scenarios, emphasizing when not to operate. Through real-world clinical cases, panelists will present multiple perspectives on patient selection, timing of intervention, risk stratification, and the balance between surgical and non-surgical management in conditions such as deep endometriosis, chronic pelvic pain, uterine scar defects, infertility, and pregnancy-related scenarios. The discussion aims to translate evidence and experience into practical insights that improve patient-centered outcomes, reduce unnecessary surgery, and support timely access to high-quality care.

Learning Objectives: At the end of this course, the participant will be able to:

1. Analyze complex gynecologic cases to determine when surgical intervention is not indicated;
2. Apply risk–benefit and outcomes-driven frameworks to guide decision-making in high-risk gynecologic scenarios; and
3. Integrate patient-centered principles into operative and non-operative management strategies.

COURSE OUTLINE

2:00 PM Welcome, Introduction and Course Overview

A. Paiva Monteiro Bilhar

2:05 PM Real-World Clinical Decision-Making, Patient Selection, and Outcome Assessment

M. Canis

2:20 PM Clinical Decision-Making in High-Volume Referral Settings, Multidisciplinary Perspectives, and Balancing Surgical Indication With Patient-Centered Outcomes in Complex Gynecologic Care

M. Vieira

2:35 PM Framing Decision-Making Frameworks, Leadership in Surgical Restraint, and Outcomes-Driven Care

K. Isaacson

2:50 PM Discussion Questions & Answers

3:00 PM Adjourn