Re: Gyn: Positive margins on a LEEP
From: Larry Glazerman (l.glazerman@rcn.com)
Tue Oct 30 12:16:33 2007
Garry:
If you're doing a laparoscopic hysterectomy with the RUMI, there's no
need to go vaginally. The RUMI, when placed correctly, delineates the
entire cervix.
--
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 Oct 30, 2007, at 1:43 PM, Garry E. Siegel, M.D. wrote:
> Dear all:
>
> For some reason (the chart is not with me today), I had told the
> patient
> that I wanted to do another LEEP, probably because I seem to remember
> that the original biopsy said invasion could not be ruled out--which
> is
> different than what I posted below. I also discussed this with the
> gyn
> onc.
>
> So. . .if I posted wrong, I'm sorry, but this has generated good
> discussion.
>
> She is scheduled for a LEEP this week, and likely a hyst later.
>
> How to hyst?
>
> Since she is having pain, I feel that a laparoscope must be
> involved, so
> I'll likely do an LAVH since I'll need to go vaginally to look at the
> cervix and remove it fully.
>
> Thanks to all,
>
> Garry
>
> At Tue, 30 Oct 2007, Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.
> wrote:
>>
>> At Mon, 29 Oct 2007, Garry E. Siegel, M.D. wrote:
>>>
>>> 33 YO P2002 S/P TL, originally came in for dysmenorrhea and
>>> dyspareunia.
>>>
>>> Her intial exam was normal, but her pap was HGSIL. Directed
>>> biopsies at
>>> satisfactory colposcopy showed moderate dysplasia.
>>>
>>> LEEP in the OR--CIS with positive endo and ectocervical margins, and
>>> extensive glandular involvement.
>>>
>>> What's next?
>>>
>>> Garry
>>>
>>> --
>>> Garry E. Siegel, M.D.
>>> Private Practice
>>> Roswell, GA
>>>
>> - repeat pap in 3-6 months, new wet prep brushs are just as good as
>> ECC.
>> - Hyst, sure if that's what pt. wants, usually if pt. has other
>> pathology,adenomyosis, endometriosis , they don't need much
>> convincing.
>>
>> Very common problem, have had over a dozen in the last ten years,
>> only
>> had one actual reccurence or incomplete excision show up on follow up
>> PaP, just repeated leep and patient has been -ve for five years, some
>> women just don't want a hyst.
>> Quite a few had low grade lesion on follow up PAP's which eventually
>> turned normal.
>>
>> --
>> Take care, John
>>
>
> --
> Garry E. Siegel, M.D.
> Private Practice
> Roswell, GA
