Re: LAVH - was: GYN: LSH vs. LAVH
From: Larry Glazerman (l.glazerman@rcn.com)
Thu May 31 06:34:11 2001
Dan:
I respectfully disagree. In the face of a large uterus, with minimal
descent, the strongest support is the cardinals, imho. In that situation, I
really belive that the cardinals can be very difficult to get, and that
going laparoscopically down to the uterines or above doesn't help you get
the cardinals.
I think the IP and the utero-ovarians are easier, especially after rotating
the uterus.
At 06:29 AM 5/31/01 -0500, you wrote:
>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
--
Larry R. Glazerman, MD
Ob-Gyn at Trexlertown
610-402-0161
l.glazerman@rcn.com
