Re: Woman Claims Doctor Branded Her Uterus
From: Braun, R. Daniel (rbraun@iupui.edu)
Tue Feb 4 06:14:48 2003
This makes a little more sense. The marking then is on the anterior
surface of the uterus. In the videotape that I saw the "UK" appeared to
be placed on the top of the fundus. That wouldn't seem to me to be of
much help. Marking the midline on the anterior surface would.
Dan
-----Original Message-----
From: John R. Miklos M.D. [mailto:johnrmiklos@yahoo.com]
Sent: Monday, February 03, 2003 6:54 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Woman Claims Doctor Branded Her Uterus
Dr. Braun:
1. The website is written so a patient can understand it not to teach
someone to do a laparoscopic Doderlein hysterectomy. If you notice I do
not show even a more important part of the surgery and that is the
actual delivery of the fundus of the uterus through an anterior
colpotomy.
To do this maneuver I use two Lahey clamps and walk the up the cevix
clamp after clamp, up the midline of the uterine body until both clamps
reach the fundus. At that time a clamp is placed on each side of
midline at the fundus and the fundus of the uterus is delivered through
the anterior colpotomy.
Even when I have written papers on the subject, the editors often remove
the smaller aspects of the surgery including marking the uterus because
they do not feel it is cost effective to show pictures of the markings
nor do they feel it is important.
Actually on the set of pictures on my website the front or anterior
aspect of the uterus was marked, however the actual picture which shows
the marking of the uterus is not present and just to clarify if you
could see the anterior portion of the uterus in the picture which shows
the delivery of the uterus through the anterior colpotomy (ie vaginal
picture) the anterior uterus was marked. the problem here is that you
can only see the posterior aspect of the uterus.
Answer to Question 2
I am sure a competent gynecologist can distinguish the anterior aspect
of the uterus from the posterior uterus, however delivering the fundus
of the uterus through an anterior colpotomy is not as easy as it might
seem unless you have done it before.
In a Doderlein hysterectomy the surgeon only makes an anterior
colpotomy. No posterior colpotomy or circumferential incision is made
around the cervix. That space "anterior colpotomy" is only about 3 cm
long and about 2 cm wide. There is limited vision due to the small
space and by marking the uterus one can place his/her clamps hand over
hand into the uterus until he/she reaches the fundus. By staying in the
midline it is easier to get leverage on the uterus and deliver it
through the anterior colpotomy. If one does not have a marking and
he/she treks up the uterus off of midline, one does not get an even
torque or tension on the bulk of the uterus which can increase the
difficulty in getting the uterus to deliver through the small anterior
colpotomy.
The best way to really understand the operation is see it done. One
does not appreciate the small incision you are delivering the uterus
through until you see someone do it.
jrm
>
>First let me say that I do not do LDH's. Then let me ask a question or
>two here. 1. I don't see in the p[ictures or the descriptions on your
>web site anything about marking the uterus with a "T" or anything else.
>If it is so important to do, why isn't it shown?
>2. Explain to me any advantage to marking the uterus. For the life of
>me, I can't see why it needs to be done. If a competent Gynecologist
>can't pull the fundus of the uterus through an anterior colpotomy
>incision and distinguish the front from the back without a mark on it,
>we have failed in the training of all Gynecologists.
>I am willing to admit that I may not know enough about this procedure
to
>understand the need for this, so please educate me if that is the case.
>
>Dan
>
>-----Original Message-----
>From: John R. Miklos M.D. [mailto:johnrmiklos@yahoo.com]
>Sent: Sunday, February 02, 2003 3:37 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: Woman Claims Doctor Branded Her Uterus
>
>Outstanding Dr. Modugno!!! I think you are the first on this thread to
>make a valid legal defense statement. To understand the legal defense
>one needs to understand the operation. The operation is a laparoscopic
>Doderlein hysterectomy. Please see the following html:
>http://www.tvtsling.com/lap_proc2.shtml
>
>As Robert made reference to Dr Bill Saye 's teaching technique, marking
>the uterus is indeed an appropriate part of the surgical procedure. I
>think I can say with little reservation that Dr. Saye has more
>experience than 99% of gyns in the world in performing the laparoscopic
>Doderlein surgery. I operated with Bill for 2 years 2-3 days a week
and
>I must tell you I continue to perform the operation the way I was
>taught. To perform the surgery in what I believe is the safest manner:
>first you release the adnexa and broad ligamet, then create a bladder
>flap and then mark the uterus.
>
>Now I must tell you that I was trained to mark the uterus with a "T"
and
>not a "U" "K". I never graduated from a college, graduate school or
>medical school that starts with a letter T. My name nor my wife's name
>starts with a letter "T". I am not a sports enthusiast therefore I do
>not route for any teams' whose city or name starts with a "T". I live
>in Atlanta and therefore Georgia and those do not start with "T". My
>future childrens name will not start with a "T". Now I do use
"Tabasco"
>once a week on my eggs and that starts with a "T" so perhaps my
>politically correct collegues and the general public might be able to
>muster up a reason to sue me for malpractice. Judging from the public
>outcry as well as many of our colleagues I guess if our surgeon in
>Kentucky is guilty than many of my mentors as well as friends are
>guilty. Should one person be punished for making a UK and another not
>sued for making a "T". Or perhaps some of my collegues and possibly me
>are getting ready to get "theres".
>
>My god is the pathologist getting sued next for slicing, dicing, and
>chopping up the uterus and the "U K" insignia. Or better yet have the
>patients been informed using a true informed consent as to the fate of
>the uterus postoperatively and post pathology evaluation.
>
>I suggest then that every surgeon be held responsible for not informing
>there patient on how there pathology department disposes of there
>uterus, placenta, appendix, ovary, and panniculus. (incinerator,
>garbage disposal, waste bag???)
>
>"Mark it with a suture"? How many surgeons are trained to suture well
>enough laparoscopically that it would be time efficient to do so?
>
>Professional conduct? We should only hold our Presidents, athletes,
>entertainers, singers and lawyers to professional standards to which we
>are held!!!!!!!!! My goodness many of these people make 100 times your
>salary and they can make mistakes, spit of spectators, sexually
harrass,
>swear on television, expose themselves or put a man in prison for 20
>years (as recently described o televsion about an inmate in Texas) and
>then find out via DNA tests that he was absolutely 100% innocen. The
>innocent victim was handed $50.00 and the clothes he came to prison
with
>and say adidios, so long, good by without a single repercussion to the
>judge, lawyers or the prison system.
>
>My Kentucky colleague has my support and my medical expert opinion if
he
>wants it. In fact I have already offered it. But in fact a man with
>far superior surgical skill has already beaten me to the punch. Thank
>goodness I still can make my own educated, logical and well thought out
>opinions and decisions and not have the media dictate them for me. Let
>us not judge this surgeon to harshly for if we do, I promise it will
>come back to haunt us all.
>
>Sincerely
>
>--
>John R. Miklos M.D.
>http://www.UROGYNECOLOGYCHANNEL.COM
>Director Urogynecology & Reconstructive Pelvic Surgery
>Atlanta Center for Laparoscopic Urogynecology and
> Reconstructive Vaginal Surgery
>Atlanta Georgia
>
--
John R. Miklos M.D.
http://www.UROGYNECOLOGYCHANNEL.COM
Director Urogynecology & Reconstructive Pelvic Surgery
Atlanta Center for Laparoscopic Urogynecology and
Reconstructive Vaginal Surgery
Atlanta Georgia
