Re: Pat myself on the back
From: Richard Chudacoff (rchudacoff@mylinuxisp.com)
Tue May 15 10:35:39 2007
A good argument for using non-bladed trocars. I use the blunt tip even with
the daVinci robot. I can not remember the last bladed trocar I used
--
Richard Chudacoff, MD, FACOG
Las Vegas International Center for Advanced Gynecologic Care
(Specializing in minimally and non-invasive surgery)
3150 N Tenaya Way # 270
Las Vegas, NV 89128
Tel: (702) 360-9630
Fax: (702) 228-2343
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Diana
Saari MD
Sent: Monday, May 14, 2007 8:00 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Pat myself on the back
Careful about direct entry with Ethicon's ports. Their literature
states that the 'blade protection' is lost if there is no pneumo when
you are 'direct inserting'.
I, too, have used the Veress needle for 11+ years without injury (knock
on wood). I also inject 1/4% Marcaine before cutting for port sites and
for where I put the towel clips - which I call 'vicous towel clips',
really messing up traveling scrubs! - and have not had patients complain
of much pain from either the incisions or the punctures.
The Gelpe idea mentioned elsewhere is lovely!
At Mon, 14 May 2007, Larry Glazerman wrote:
>
>Garry:
>
>It's true that many docs don't support the vagina with TLH, as they
>might with TVH or TAH, but there's no reason why they can't. It's
>because of poor suturing skill.
>
>IMHO, that's a great argument for LSH rather than TLH.
>
>--
>Larry R. Glazerman, MD, FACOG
>St. Luke's Center for Advanced Gynecologic Care
>250 Cetronia Road
>Suite 305
>Allentown PA 18104
>484-223-3279
>484-223-2830 FAX
>glazerl@slhn.org
>
>On May 14, 2007, at 9:43 PM, Garry E. Siegel, M.D. wrote:
>
>> Don't the studies all say that the chance of organ injury are all the
>> same with all techniques, even open? That said, it takes a whole
>> lot of
>> cases to show a difference among entry techniques.
>>
>> Richard, a colleague of mine who is adept at reconstructive surgery
>> poo-poohed TLH as you don't support the vagina, etc., as you might
>> with
>> a TVH or TAH.
>>
>> Any thoughts?
>>
>> Garry
>>
>> At Mon, 14 May 2007, Rafael Haciski wrote:
>>>
>>> I guess it's all a matter of personal preference. I have never had a
>>> problem in 20 years of laparoscopies with a veress needles, OTOH I
>>> have seen someone enter bowel with the direct optical trochar, and
>>> personally I am not sure what I am looking at while doing it.
>>>
>>> Reading the pressures with the Veress is key, you must have low
>>> pressures, and if not sure, tehn withdraw and re-enter. On occasion
>>> I have had to enter vaginally with the Veress, and sometime in the
>>> LUQ midcostal.
>>>
>>> Patting ourselves on the back, I had the same outcome in a 84 year
>>> old lady, went out socializing the next day - biggest handg up is
>>> usually recovering from the anesthesia, not the surgical component.
>>>
>>> --
>>> Rafael Haciski MD FACOG
>>> Naples, FL.
>>>
>>> On May 14, 2007, at 11:44 AM, Richard Chudacoff wrote:
>>>
>>>> e abdomen with towel clips. If not then I prefer using an optic
>>>> trocar and
>>>> going in directly. I have no good reason for one or the other. The
>>>> Veress
>>>> needle scares me, so I would not let a resident do it; maybe a
>>>> laparoscopic
>>>> fellow. To my knowledge I have never injured bowel with either the
>>>> Veress
>>>> nor the direct entry.
>>>
>> --
>> Garry E. Siegel, M.D.
>> Private Practice
>> Roswell, GA
>
--
Diana Saari MD FACOG
guto0002@tc.umn.edu
University Specialists in Women's Health
Minneapolis, MN
