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Re: LSH was UAE Option From: William McIntosh (wdmcintosh@charter.net) Sat Aug 28 09:28:13 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" In reply to: RModugno@aol.com: "Re: LSH was UAE Option" Next in thread: Rafael Haciski: "Re: LSH was UAE Option" Reply: Rafael Haciski: "Re: LSH was UAE Option" Morcellating in situ is tricky. In all the lectures I have attended about this procedure, it was listed as what you try when you can't get around the fibroids or whatever to isolate the uterine vessels, so you are trying to tissue reduce to avoid procedure conversion to an open case. The only time I tried it, it was a bloodbath. I got it done, but I will very hesitant to try it again. The efficiency of your morcellator is the real key to this LSH. I have the Gynecare II, and I am very pleased. I have morcellated out some 20 week sized uteri in just 5-10 minutes. To be honest, the time for morcellation for me seems to have more to do with whether I can get the "apple peel" thing going on a given day. The ones that take longer than 5-10 minutes are the ones where I chew it to pieces, and then have to go retrieve all the little bits. As much as I might like to blame that on the machine, I think that has more to do with me. -- William D. McIntosh, MD, FACOG Premier Medical Group Clarksville, TN wdmcintosh@charter.net -----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 9:26 PM To: Multiple recipients of list OB-GYN-L Subject: Re: LSH was UAE Option In a message dated 8/27/2004 9:59:36 PM Eastern Daylight Time, garrys@mindspring.com (Garry E. Siegel, M.D.) writes: >Larry: > >Agree that the morcellation takes a good while if the uterus is big. > >What is your sequence of events, i.e. > >1.  Secure the infudibulo-pelvis or utero-ovarians and rounds. >2.  Disconnect from the fundus. >3.  Create a bladder flap. >4.  Secure the uterines. >5.  Morcellate in-situ. > >Morcellation while attached (I've never done it) sounds like it might be >easier, as the uterus is held still by its attachment to the cervix. > >On the other hand, it seems like it might bleed more, as normally I >amputate, put the specimen aside in the abdomen, and acheive hemostasis >on the stump and THEN morcellate. > >What do you do? > >Do others leave the uterus attached? > >Garry > >PS--agree with William that someone with good lapscope skills can do >these with a bit of coaching.  That is how I learned, so I guess my >comment is a bit self-serving. > >-- >Garry E. Siegel, M.D. >Private Practice >Roswell, GA > Went to a meeting at our hospital in Atlanta, where a guy from out of town showed a video where he morcellated the uterus "in situ". Tom Lyons, one of the "gurus" of LSH was in the audience. He was not pleased with this technique. He believed it was a disaster waiting to happen. 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" In reply to: RModugno@aol.com: "Re: LSH was UAE Option" Next in thread: Rafael Haciski: "Re: LSH was UAE Option" Reply: Rafael Haciski: "Re: LSH was UAE Option"

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