Re: Pat myself on the back-lets discuss OBG vs just G
From: D. Ashley Hill (dahmd@cfl.rr.com)
Tue May 15 20:53:52 2007
Most of the members of my department perform a bilateral uterosacral
ligament suspension (by performing each side separately) for TLH or TVH
procedures (we don't do too many TAH's any more). Other than a little
increased OR time, the main concern is ureteral injury or kinking.
Richard, do you routinely perform cystoscopies after laparoscopic USL
suspensions (assuming you use this procedure for suspensions) or do you
feel the post-procedure visualization of normal peristalsis is adequate?
Thanks, Ashley.
At Tue, 15 May 2007, Richard Chudacoff wrote:
>
>Many doctors don't suspend the vagina after a TAH or TVH as well. That is a
>great argument for separation of Obstetrics from Gynecology
>
>--
>Richard Chudacoff, MD, FACOG
>Las Vegas International Center for Advanced Gynecologic Care
>(Specializing in minimally and non-invasive surgery)
>3150 N Tenaya Way # 270
>Las Vegas, NV 89128
>
>Tel: (702) 360-9630
>Fax: (702) 228-2343
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Larry
>Glazerman
>Sent: Monday, May 14, 2007 7:47 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: Pat myself on the back
>
>Garry:
>
>It's true that many docs don't support the vagina with TLH, as they
>might with TVH or TAH, but there's no reason why they can't. It's
>because of poor suturing skill.
>
>IMHO, that's a great argument for LSH rather than TLH.
>
>Larry R. Glazerman, MD, FACOG
>St. Luke's Center for Advanced Gynecologic Care
>250 Cetronia Road
>Suite 305
>Allentown PA 18104
>484-223-3279
>484-223-2830 FAX
>glazerl@slhn.org
>
>On May 14, 2007, at 9:43 PM, Garry E. Siegel, M.D. wrote:
>
>> Don't the studies all say that the chance of organ injury are all the
>> same with all techniques, even open? That said, it takes a whole
>> lot of
>> cases to show a difference among entry techniques.
>>
>> Richard, a colleague of mine who is adept at reconstructive surgery
>> poo-poohed TLH as you don't support the vagina, etc., as you might
>> with
>> a TVH or TAH.
>>
>> Any thoughts?
>>
>> Garry
>>
>> At Mon, 14 May 2007, Rafael Haciski wrote:
>>>
>>> I guess it's all a matter of personal preference. I have never had a
>>> problem in 20 years of laparoscopies with a veress needles, OTOH I
>>> have seen someone enter bowel with the direct optical trochar, and
>>> personally I am not sure what I am looking at while doing it.
>>>
>>> Reading the pressures with the Veress is key, you must have low
>>> pressures, and if not sure, tehn withdraw and re-enter. On occasion
>>> I have had to enter vaginally with the Veress, and sometime in the
>>> LUQ midcostal.
>>>
>>> Patting ourselves on the back, I had the same outcome in a 84 year
>>> old lady, went out socializing the next day - biggest handg up is
>>> usually recovering from the anesthesia, not the surgical component.
>>>
>>> --
>>> Rafael Haciski MD FACOG
>>> Naples, FL.
>>>
>>> On May 14, 2007, at 11:44 AM, Richard Chudacoff wrote:
>>>
>>>> e abdomen with towel clips. If not then I prefer using an optic
>>>> trocar and
>>>> going in directly. I have no good reason for one or the other. The
>>>> Veress
>>>> needle scares me, so I would not let a resident do it; maybe a
>>>> laparoscopic
>>>> fellow. To my knowledge I have never injured bowel with either the
>>>> Veress
>>>> nor the direct entry.
>>>
>> --
>> 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
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