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Re: Gyn: How to approach a caseFrom: Richard Chudaoff (rchudacoff@mylinuxisp.com)Mon Aug 21 17:37:04 2006
Garry If you don't scope her first, then you will never know which cases are scope cases and which cases are open cases. I'm performing my first scheduled open case in three years Wednesday for an 11x25x28 cm uterus, only because MRI suggests it is a leiomyosarcoma. Example...patient with three previous c-sections and a 16 week sized uterus for hysterectomy. We scoped her and the omentum was entirely plastered to the anterior abdominal wall and anterior of the uterus. Had we opened her, it would have taken 30-45 minutes to just get into the pelvis. Instead we just did the procedure under the omentum, skin to skin in 65 minutes. However, if there is no one else available I am always willing to travel and teach laparoscopic surgery, or have you come out to Houston. Richard Chudacoff, MD, FACOG -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E. Siegel, M.D. Sent: Monday, August 21, 2006 5:08 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Gyn: How to approach a case Dear all: Thanks for the input. I am contemplating a transverse incision, likely a Maylard to get more room to work if it is a mess. However, given the fact that this could be an adherent mess, I have thought about a midline one, with my only hesitation being the fact that she's diabetic. We all have different levels of comfort and skill with LAVH/LSH etc. With utmost respect to Richard and Larry, I don't think that this is a lapscope case, and would you answer that way if it was for your oral boards? Larry, you may not do any open cases anymore, but I think that a small role remains for selected open cases other than oncology ones. If she is having a total hysterectomy/BSO for chronic PID, I can't see leaving her cervix (and, she's diabetic and immunocompromised, and at risk for dysplasia), and I can't see what is at all wrong with an open approach. For me, the tactile sensation and soft, blunt lysis of adhesions for a "pus" case is a safer and better approach. Garry
At Mon, 21 Aug 2006, rmodugno@aol.com wrote:
>
>************************
-- Garry E. Siegel, M.D. Private Practice Roswell, GA
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