Re: LAVH - was: GYN: LSH vs. LAVH
From: Joanne Bulley (islesannie@yahoo.com)
Thu May 31 21:37:11 2001
I gotta agree with Dan and Gerald...
VH and Morcellate!
Joanne
At Thu, 31 May 2001, Gerald P. Rodriguez wrote:
>
>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
>>
--
Joanne Bulley, MD, FACOG
Keene, NH, USA
