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Re: LSH was UAE Option From: William McIntosh (williammcintosh@msn.com) Fri Aug 27 10:22:06 2004 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Richard Chudacoff, MD: "Re: LSH was UAE Option" Previous message: Garry E. Siegel, M.D.: "Re: LSH was UAE Option" I think that almost any competent laparoscopist could quickly acquire the skills to perform a LSH in less than an hour on average. I have done about 110 over the past 2 years. The average time for the first 10 was about 75 minutes, but since then my average is 45-50, with some as short as 30. It is NOT a difficult procedure if you have basic laparoscopy skills and a good morcellator. The only "new" skills you need involve the amputation of the cervix from the fundus, and using the morcellator itself. 1. harmonic scalpel 2. no, but I do cover it with Interceed 3. bipolar cautery William D McIntosh MD FACOG Clarksville, TN >----- Original Message ----- From: RModugno@aol.com To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net> Sent: Friday, August 27, 2004 7:53 AM Subject: Re: LSH was UAE Option > In a message dated 8/26/2004 6:38:44 PM Eastern Daylight Time, ENDODOK@aol.com writes: > > >I inform the patient of all options including "doing nothing". When I > >compare a "one hour-home the same day- treat other associated conditions (endo?)- > >resume 95-99% ALL ACTIVITIES, including sex, in 5-7 days, LSH" to UAE ( cost, > >pain, continuation of periods) the vast majority of patients choose LSH. I > >had to deal with 2 post-embolization syndrome patients ( pain, chills fever > >etc) and have so informed the interventional radiologists that they MUST deal > >with these problems, not the primary gynecologist. > > Kaiser in Santa Monica recently compared costs of LSH vs TAH. > >LSH=$5000. TAH= $9000. LSH the hysterectomy procedure of choice in Kaiser > >San Diego > >hospitals. No way can UAE compete cost wise. > > The MRI -controlled focused ultrasound ("ExAblate"?) procedure developed > >in Israel reportedly destroys fibroids without pain, or surgical > >intervention. The company has applied for FDA approval here in USA. This might put gyn > >surgeons out of business. > > > >J.Glenn Bradley MD > > > > Interesting post Glenn.I assume, however that most general gynecologists cannot complete a LSH in one hour. I also assume that many general gynecologists could do a TAH or TVH within an hour or thereabouts. The reimbursement rate in Georgia for hysterectomies of all types ( excluding radicals), is about 850 to 950 dollars. Soooo... it may be cost effective for the physician to do the procedure they are most adept at, in the shortest time, rather than a "foreveroscopy". At our institution we have to present proof of a training session in the use of the power morcellator - as you know these injuries never occur with TAH or TVH. > > Some technical questions: > 1)What do you use to amputate the uterus in LSH? > 2)Do you suture the cervical stump? > 3) How do you secure the uterine artery pedicles? > > Robert Modugno MD MBA FACOG > Marietta, GA > http://www.novaobgyn.yourmd.com Next message: Richard Chudacoff, MD: "Re: LSH was UAE Option" Previous message: Garry E. Siegel, M.D.: "Re: LSH was UAE Option"

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