Re: How to approach a case LH v LAVH
From: D. Ashley Hill (dahmd@cfl.rr.com)
Tue Aug 22 21:53:49 2006
Garry-
I find that I am more comfortable dissecting the bladder off of the
fundus or lower uterine segment laparoscopically than via an open
approach, although it took some time to get that way. With the scope
you don't have the same tactile sense, but you get a lot of fine control
and optical magnification.
Ashley
At Mon, 21 Aug 2006, Garry E. Siegel, M.D. wrote:
>
>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
>
--
D. Ashley Hill, MD
Associate Director
Department of Obstetrics and Gynecology
Florida Hospital Family Practice Residency
Medical Director, Loch Haven Ob/Gyn Group
Division Director, Dept. of Ob/Gyn, Florida Hospital Orlando
Orlando, Florida
