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Re: Gyn: complex hyperplasia with atypia From: Garry Siegel (garrys@mindspring.com) Sat Jan 20 10:52:06 2001 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Anna Meenan, MD: "Re: breastfeeding/cabbage" Previous message: maggiecnm: "Re: What do you do?" In reply to: RModugno@aol.com: "Re: Gyn: complex hyperplasia with atypia" Next in thread: Steve & Eryl Raymond: "Re: Gyn: complex hyperplasia with atypia" > >Well, Garry - here are my questions: > >Do you plan to take out her ovaries? In other words if you were approaching >her abdominally, you would remove her ovaries, right? Therefore if you feel >comfortable removing them from below and/or they are accessible - then >vaginal approach is fine. Well, that is a good question, and I continue to work under the assumption that a TVH beats an LAVH. In the past, many of us have approached cases like this and planned to remove ovaries with the TVH if accessible; however, if they were not, then leave them in. Nowadays, it is not as clearcut, and I could argue in favor of, or against *always* starting a normal TVH with the scope to detach the ovaries. The purists will poo-poo the "LAVH to get the ovaries approach," yet we can't get all of the ovaries all of the time vaginally. **Anyone ever do a TVH, not be able to get the ovaries, close the cuff and then put in a scope to get them detached, and then bring them out through the re-opened cuff? I've also heard of stuffing a lap pad into a glove, thereby creating a seal in the vagina (leaving the cuff open) to put in a scope and detach ovaries.*** >If not, then LAVH approach is great. Could do a frozen section beforehand - >but you need to ask yourself - would it change approach? With this history it >would be unlikely that she has a deeply invasive/anaplastic endometrial >carcinoma. Could still do an LAVH with friendly GYN oncologist to do pelvic >lymphadecectomy if indicated.Have had cases of CA endometrium done with this >approach where Matt Burrell ( local gyn onc for our listers) has done the >lymphadenectomy portion laparoscopically. FWIW, another local gyn onc (Feuer) would rather just do a TAH BSO nodes--because it takes 1/2 as long, and he thinks that it is a better operation. Having done both one day this past year with him, it is hard to argue with his logic, and his skills/technique/efficiency are excellent. > >A preoperative vaginal ultrasound will also give you an accurate estimate of >the uterine size if you're worried about morcellation. > Instead of an ultrasound to estimate the uterine size, I used both of my hands :). I don't think that it will need morcellation, but as we all know, if the TVH gets hard, morcellation is a great technique. Garry -- Garry E. Siegel, M.D., F.A.C.O.G. Roswell, GA Private Practice Next message: Anna Meenan, MD: "Re: breastfeeding/cabbage" Previous message: maggiecnm: "Re: What do you do?" In reply to: RModugno@aol.com: "Re: Gyn: complex hyperplasia with atypia" Next in thread: Steve & Eryl Raymond: "Re: Gyn: complex hyperplasia with atypia"

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