Re: Gyn: Hysterectomy; Is there more than one way to skin a cat?
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Fri Sep 21 16:09:22 2007
Dan:
You said what I meant to say much better. I was meaning to say
something like "It is OK to do an open case rather than a laparoscopic
one if you can do it "better" via the technique with which you're
familiar."
For instance, some may prefer to do an ovarian cystectomy for a
suspected dermoid open to avoid spill, or some may do an ectopic open at
3 AM due to lack of support, etc.
Garry
At Fri, 21 Sep 2007, R. Daniel Braun wrote:
>
>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
>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
