Re: LAVH - was: GYN: LSH vs. LAVH
From: Gerald P. Rodriguez (geraldpr@cybermesa.com)
Thu May 31 08:09:57 2001
It depends on the cause of the enlargement; if it's fibroids or adenomyosis
the cardinals are easy (unless there are cervical fibriods). I think many
younger gyns have not the training/experience in morcellation, hence fear to
go there.
--
Gerald P. Rodriguez, M.D., FACOG
Santa Fe, NM
>----- Original Message -----
From: "Larry Glazerman" <l.glazerman@rcn.com>
To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@mail.medispecialty.com>
Sent: Thursday, May 31, 2001 5:36 AM
Subject: Re: LAVH - was: GYN: LSH vs. LAVH
> 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
>
