I do have a couple of questions. I do tell the LSCH patients to restrict for
heavy physical activity for two weeks, as well as no intercourse. The TVH or
TAH patients this is 6 weeks. Does anyone do any differently?
--
Richard Chudacoff, MD
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Braun, R.
Daniel
Sent: Friday, August 27, 2004 9:59 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: LSH was UAE Option
Sounds like you do the operation and then never see the patient again????
Dan
R. Daniel Braun, MD
"If everyone likes you, you're doing something wrong."
Kinky Friedman
I believe a self-righteous liberal or conservative with a cause is more
dangerous than a Hell's Angel with an attitude.
Andy Rooney
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Richard
Chudacoff, MD
Sent: Friday, August 27, 2004 9:42 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: LSH was UAE Option
It should not take much longer than an LAVH, prior to going below. Therefore
an hour to 90 minutes, max. Morcellation only takes 5 minutes and then your
done. The benefit is no rounding the next day, no staple removal and no six
week post op exam 1. I use the harmonic scalpel 2. Usually just cauterize
and place Surgicel 3. Bipolar cautery-Kleppinger
Richard Chudacoff, MD
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
RModugno@aol.com
Sent: Friday, August 27, 2004 7:53 AM
To: Multiple recipients of list OB-GYN-L
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
