Re: Gyn: Positive margins on a LEEP
From: R. Daniel Braun (rd.braun@gmail.com)
Tue Oct 30 18:32:14 2007
Yeah but sometimes the lesion goes off the cx onto the vagina. If you do it
vaginally you can take care of that.
Dan
On 10/30/07, Larry Glazerman <l.glazerman@rcn.com> wrote:
>
> 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
>
--
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
