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Re: LAVH - was: GYN: LSH vs. LAVH From: Braun, R. Daniel (rbraun@iupui.edu) Thu May 31 06:26:45 2001 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Larry Glazerman: "Re: LAVH - was: GYN: LSH vs. LAVH" Previous message: Griffiths Malcolm: "Re: Degenerated fibroid and pregnancy" The toughest part of a VH is the IP's. The cardinals are duck soup, only the Uterosacrals are easier. Dan -----Original Message----- From: Larry Glazerman [mailto:l.glazerman@rcn.com] Sent: Wednesday, May 30, 2001 9:24 PM To: Multiple recipients of list OB-GYN-L Subject: LAVH - was: GYN: LSH vs. LAVH Garry: Unencumbered by data, I'm a fan of LSH - I think there's quicker recovery than LAVH, quicker return to sexual function, better vaginal suport, and MAYBE better sexual function. Harry Hasson wrote a pretty good paper about this a few years ago, but I can't put my finger on it at the moment. BTW, I don't ever understand the rationale for LAVH. My theory is that what most people call an LAVH is really a TVH with some laparoscopic assitance. IMHO, the toughest part of a TVH is the cardinal ligaments. The laparoscopic guidance doesn't help the cardinals at all, so if you can't get them vaginally, the laparoscope doesn't help you. A TLH, on the other hand, makes more sense to me. I'm ready for any and all flames. -- Larry Glazerman At 07:06 PM 5/30/01 -0500, you wrote: >I have a 46 YO with 14 week fibroids, who is having her planned hyst >tomorrow. This has been discussed ad nauseum in the office, and the >date was set last fall. Because her uterus was 14 weeks clinically, I >did not feel that I could do a TVH, and she wanted to avoid a TAH. Thus, >she's been on lupron, and I'm planning an LAVH/BSO (she requests the >BSO). > >We sat down to talk yesterday, and I kicked around a LSH with her. I >then went over the supposed advantages and disadvantages, and her >concerns centered around the possibility of pain with cervical >retention, versus the possible benefit of retention such as pelvic >relaxtion, sexual function, etc. > >Factors such as the need for paps, OR time, recovery time were >nonfactors to her--her concern was long term. For the sake of >discussion, we pretty much didn't worry about cervical cancer, either, >as she has a negative history, is low risk, and has had normal paps >forever. > >How do you counsel patients on LSH (laparoscopic supracervical hyst) >versus LAVH? Does anyone have any references to compare long term >outcomes (I'm going looking, too), especially given that both procedures >are relatively new, especially the LSH? > >Garry > >PS--this patient is going to do an LAVH, mainly because that is what she >has had in her mind for months. > >-- >Garry E. Siegel, M.D., F.A.C.O.G. >Roswell, GA >Private Practice Larry R. Glazerman, MD Ob-Gyn at Trexlertown 610-402-0161 l.glazerman@rcn.com Next message: Larry Glazerman: "Re: LAVH - was: GYN: LSH vs. LAVH" Previous message: Griffiths Malcolm: "Re: Degenerated fibroid and pregnancy"

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