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Re: LSH In-Situ morcellationFrom: ENDODOK@aol.comSat Aug 28 10:07:49 2004
The key to avoiding the "in-situ morcellation bloodbath" is the certainty of the fundal devascularization. Once the uterine vessels have been coapted, the entire fundus must be violacious; if not totally ischemic, that means you still have an active blood supply. Go back and re-coagulate the uterine vessels. Would suggest that transection of the uterines be deferred until size reduction accomplished, as the manipulation of the fundus during morcellation may unseal the vessels, and then you have a big problem and may have to open. One further pitfall to avoid IMHO. In the peeling process, be careful of the vessels on the contralateral side as traction on the fundus tends to pull it upwards (cephalad) and one can cut below the site of vessel coaptation/dessication. My observations based on 700 LSH procedures. J.Glenn Bradley MD
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