Re: How to approach a case LH v LAVH
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Mon Aug 21 21:05:36 2006
I'm enjoying the dialog.
FWIW, there are many LAVHs/LSHs that I do where I start out with a
scope, and decide whether to proceed via the scope versus open.
For those doing LAVHs, or LHs (total laparoscopic hysts), how do you
handle the bladder flap if she's had a couple of sections? That is one
place where I like the "hands on" approach.
Garry
At Mon, 21 Aug 2006, Richard Chudaoff wrote:
>
>1. I like to approach it like in intrafascial hysterectomy and onion skin it
>if possible, starting above the uterosacral ligaments. If not possible then
>make an anterior and posterior incision, using the uterus to maintain the
>pneumo, and then meet the incision staying above the uterine vessel ligation
>2. ACE harmonic from J&J/ Ethicon
>3. I either use a ConMed V Care or a wet wound towel
>4. ConMed V Care or sponge stick with a gauze
>5. Interrupted simple or figure of eight sutures. If I use a daVinci I tie
>intracorporal, if not then either extracorporal sutures with know pusher or
>use the Endosuture
>
>Richard Chudacoff, MD, FACOG
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Rafael
>Haciski
>Sent: Monday, August 21, 2006 8:02 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: How to approach a case LH v LAVH
>
>I agree that laparoscopic hysterectomy is easier. But I am curious
>about different methodologies employed by the esteemed members of
>this list:
>
>Having transected the uterine lateral attachments, what is your
>preferred method for finishing the hysterectomy:
>. simple incision into the vagina from above?
>. what instrument do you prefer to use for this incision?
>. how do you maintain pneumoperitoneum
>. what instruments do you like to have in the vagina for that portion?
>. what do you do with the cuff?
>
>Rafael Haciski MD FACOG
>Palmetto, FL
>
>On Aug 21, 2006, at 10:18 AM, Richard Chudaoff wrote:
>
>> Begs the question, if you are going to do an LAVH, why not an
>> LH...I think
>> they are easier, quicker and less complicated
>>
>> Richard Chudacoff, MD, FACOG
>>
>> -----Original Message-----
>> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
>> ainsron
>> Sent: Monday, August 21, 2006 9:08 AM
>> To: Multiple recipients of list OB-GYN-L
>> Subject: RE: How to approach a case
>>
>> Why not start with LAVH/BSO and convert to laparotomy - Pfannensteil
>> incision- if necessary?
>>
>> Ronald E. Ainsworth, 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: Sunday, August 20, 2006 8:00 PM
>> To: Multiple recipients of list OB-GYN-L
>> Subject: Gyn: How to approach a case
>>
>> 40 YO P1001, insulin requiring diabetic, was hospitalized by her FP 3
>> weeks ago with a febrile illness, and likely had bilateral small
>> TOAs or
>> at least hydrosalpinges on CT. I saw her a couple of days after
>> admisssion, and she gave a vague but convincing story of prior
>> problems
>> with cysts treated with antibiotics, and maybe an infection. Long
>> story
>> short, she sounds like chronic PID with an exacerbation, likely
>> worsened/complicated by IDDM.
>>
>> A follow-up CT at discharge (the FP ordered it) showed bilateral 3
>> or 4
>> cm. hydrosalpinges.
>>
>> She is of normal build, and her exam recently was pretty benign--
>> she was
>> markedly less tender, a retroverted, normal sized uterus and no
>> masses.
>>
>> I am planning a TAH-BSO soon, and plan a bowel prep.
>>
>> What type of incision would you make?
>>
>> Garry
>>
>> --
>> Garry E. Siegel, M.D.
>> Private Practice
>> Roswell, GA
>>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
