Re: LSH was UAE Option
From: Richard Chudacoff, MD (rchudacoff@mylinuxisp.com)
Sat Aug 28 09:49:23 2004
And some less
--
Richard Chudacoff, MD
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Larry
Glazerman
Sent: Friday, August 27, 2004 5:51 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: LSH was UAE Option
Depending on the size of the uterus, morcellation can take LOTS more than 5
minutes. I do some very large LSHs, which take a lot of time to morcellate.
Larry R. Glazerman, MD
Ob-Gyn at Trexlertown, PC
610-402-0161
l.glazerman@rcn.com
> -----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 10:42 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
>
