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Re: GYN: Residual uterine tissue after subtotal hysterectomy--longFrom: Garry E. Siegel, M.D. (garrys@mindspring.com)Thu Dec 25 12:02:33 2003
Thanks for replies--very fascinating case to me with lots of issues and options. 1. The ultrasound report gives the measurements, and also states that a long cervix was present. I have not seen the pictures, but may do so, or call the radiologist (it was done elsewhere--not in my "system")and ask him/her to review and comment. 2. I have thought of doing a gentle hysteroscopy/curettage, and would do so in the OR with the thought of putting in a laparoscope for guidance if needed. I don't think it wise--or maybe I'm too conservative--to simply try a blind office endometrial biopsy. Obviously, had she had a normal uterus, it would have been done. 3. With respect to the details of the surgery, I'm not sure why a BSO was done, nor am I sure why the regular gyn had the gyn onc scrub in, unless the regular gyn expected a problem. The op note is vanilla, and doesn't describe terrible adhesions, difficulty with the bladder dissection, etc. Actually, it describes a TAH!--so the dictating MD, the gyn onc (who is a friend, and out of town, and with whom I'll speak next week about the case)simply did his dictation from rote memory and made a "typo," as we all do* from time to time. The patient told me that the gyn onc wanted everything taken out, but the regular gyn suggested preserving the cervix, so it seems likely that the regular gyn and/or patient decided on a subtotal beforehand, rather than intraoperatively due to difficulties, etc. 4. If removal is planned, my gut says to cosider doing this via the vaginal route with a laparoscope in, and have a low threshold to open to do it. Garry *By typo, I mean that sometimes we may make a dictation error. I've certainly seen some of mine over the years; for instance, forgetting to put "tubal ligation" in the name of the operation at a repeat section, yet the text describes that I did it, and there are tubes in pathology report.
-- Garry E. Siegel, M.D. Private Practice Roswell, GA
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