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Re: Gyn: Hysterectomy; Is there more than one way to skin a cat? From: R. Daniel Braun (rd.braun@gmail.com) Fri Sep 21 15:41:50 2007 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Garry E. Siegel, M.D.: "Re: Gyn: Hysterectomy; Is there more than" Previous message: l.glazerman@rcn.com: "Re: Gyn: Hysterectomy; Is there more than" In reply to: Garry E. Siegel, M.D.: "Gyn: Hysterectomy; Is there more than one way to skin a cat?" Next in thread: Garry E. Siegel, M.D.: "Re: Gyn: Hysterectomy; Is there more than one way to skin a cat?" Reply: Garry E. Siegel, M.D.: "Re: Gyn: Hysterectomy; Is there more than one way to skin a cat?" On 9/21/07, Garry E. Siegel, M.D. <garrys@mindspring.com> wrote: > > Over the past few months, "how" to perform a hysterectomy has been on my > mind, with several diverging options and opinions. This all may be > based on personal preference, skill, equipment availablity, etc. We all > agree that if you do an operation well, and if several operations meet > the patient's needs, it is better to do the operation you do best. . NO!! It is best to do the operation that the patients anatomy and pathology dictates. Different strokes for diferent folks . That is why I tell(Oops, TOLD) the residents, that they can' learn just one way. They have to learn as many ways as possible, so that they will be ready for whatever comes at them. .. > > Anyway, for discussion, I would like to focus on the surgical options > and techniques, and rationale, if any, behind what one does. This may > bleed over into cervical retention versus removal, which, to a degree, > may influence what is done and how it is done. > > 35 YO P3003, all vaginal deliveries, who has completed her family, with > disabiling menorrhagia (normal CBC) and dysmenorrhea, who cannot/will > not use hormonal contraception (hemiplegic migraines per her), and has a > strong family history of endometriosis. Her exam, ultrasound, and CBC > are normal. She requests a hysterectomy with ovarian retention. > > FWIW, she underwent a LAVH yesterday unremarkably, with a normal pelvis > and pathology pending. > > So. . . > > What about Total Laparoscopic Hysterectomy (TLH)? Laparoscopic > Supracervical Hysterectomy (LSH)? Old-fashioned TVH? Did she need a > laparoscopy? (I think so). If so, why not a diagnostic laparoscopy and > then TVH? PLAIN OLD VAGINAL HYSTERECTOMY BY WHICHEVER TECHNIQUE WORKS BEST FOR HER. No Laparoscopy, Minimally invasive surgery is the LEAST invasive method and that is vaginal. NO Abdominal incision. Dan If you do a TLH, might you be "missing" the chance to support the > vaginal to the uterosacrals as one might do vaginally? Is it needed? > McCalls? > > Might you avoid this with an LSH? But, if you do an LSH, might the stump > contain suspected adenomyosis? > > All food for thought--discussion welcome. > > -- > Garry E. Siegel, M.D. > Private Practice > Roswell, GA > -- R. Daniel Braun, MD FACOG(L) CMT Professor Emeritus Dept. of Obstetrics and Gynecology Indiana U. School of Medicine R. Daniel Braun "Science without Religion is LAME; Religion without Science is BLIND" Einstein 1941 Next message: Garry E. Siegel, M.D.: "Re: Gyn: Hysterectomy; Is there more than" Previous message: l.glazerman@rcn.com: "Re: Gyn: Hysterectomy; Is there more than" In reply to: Garry E. Siegel, M.D.: "Gyn: Hysterectomy; Is there more than one way to skin a cat?" Next in thread: Garry E. Siegel, M.D.: "Re: Gyn: Hysterectomy; Is there more than one way to skin a cat?" Reply: Garry E. Siegel, M.D.: "Re: Gyn: Hysterectomy; Is there more than one way to skin a cat?"

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