Re: All in a Day's Work!
From: D. Ashley Hill (dahmd@cfl.rr.com)
Fri May 18 10:39:31 2007
I can't say that I ever would have thought of holding the labia
together. I'll try it next week. Thanks,
Ashley
At Fri, 18 May 2007, Richard Chudacoff, MD wrote:
>
>Another way is just having the tech hold the labia together. Nick Spirtos
>showed it to me in LV and it works as well as anything I have done
>previously
>
>--
>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
>
>
>email:
> richard.chudacoff@obgyn.net
> rchudacoff@mylinuxisp.com
> rchudacoff@deployedmedical.com
> rchudacoff@lasvegasgyncenter.com
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of D. Ashley
>Hill
>Sent: Thursday, May 17, 2007 7:16 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: All in a Day's Work!
>
>Garry- We close our TLH cuffs laparoscopically. There are several ways
>to assure pneumoperitoneum after the uterus is detached. Lately I've
>been pulling the uterus to the hymen then leaving it there to tamponade
>the vagina. Closing the cuff is generally easy this way. Have a nice
>weekend.
>
>Ashley
>
>At Thu, 17 May 2007, Garry E. Siegel, M.D. wrote:
>>
>>FWIW, my partner who is skilled in laparoscopic surgery did his first
>>TLH, and it went well.
>>
>>She had postop bleeding/decreasing hematocrit, and, long story short,
>>had to return to the OR for cuff bleeding. He said that cuff closure,
>>done vaginally, had been difficult. It was easy when her abdomen was
>>opened!
>>
>>Garry
>>
>>At Wed, 16 May 2007, R. Daniel Braun wrote:
>>>
>>>You go, Girl.
>>>"They are all doing great this evening" That is the same thing they say
>>>about their TLH's. I bet you were actually operating for at the most 4
>>>hours. I bet it would take a lot longer to do 3 TLH's of this magnitude.
>And
>>>your ladies all have "0" cm incisions on their abdomens.
>>>
>>>Dan
>>>
>>>On 5/16/07, Joanne Bulley, MD <islesannie@gmail.com> wrote:
>>>>
>>>> Hi listers
>>>>
>>>> Today I had 3 of my hardest vag hysts...
>>>>
>>>> Each case was interesting to say the least!
>>>>
>>>> Case # 1 - obese woman Vag Deliv X 3 (prior infertility patient of mine
>>>> .. those kids are now 18 - 21!). DUB and fibroids no response to
>>>> progesterone agents and had symptoms from the fibroid uterus hitting the
>>>> bladder. Not a lot of prolapse - but since she was quite obese I
>>>> decided to go for it as a straight VH. Needed morcellation. She is
>>>> doing great this evening.
>>>>
>>>> Case #2 - Slim woman G7P6016 - I took care of her for many of her
>>>> pregnancies. S/p hysteroscopic ablation at time of TL (back when we did
>>>> roller balls etc) - that failed and she went for another ablation rather
>>>> than a VH 3 years ago. Now menopausal and on ClimaraPro. ER visit for
>>>> abdominal / back pain with sciatica. The ER of course gets CT and she
>>>> has a uterus filled with fluid. Followed by US. Diagnosis -
>>>> hematometra from cervical obstruction due to the novasure. Also uterine
>>>> walls hypertrophied. Long hard case - when I morcellated the uterus -
>>>> the cervix was indeed completely blocked about 1.5 cm from the external
>>>> os and the uterus was filled with that thickened gooey chocolate fluid
>>>> of old blood. Under pressure also - when I incised it the stuff was all
>>>> over my surgical gown. Changed that of course. She is doing great this
>>>> evening.
>>>>
>>>> Case #3 - Para 3 - all vaginal, largest 9#10oz. US with primary care
>>>> showed fibroids and thickened endometrium and herterogeneous myometrium
>>>> (adenomyosis &/or fibroids). Very obese - very short waisted. Exam in
>>>> office - hard access to cervix without the tenaculum for the endo
>>>> biopsy. Nothing pathologic on Endo Biopsy. She wants definitive
>>>> treatment of symptoms. EUA made me decide to go Vag (knowing it was
>>>> going to be tough) - and after really earning what meager pay the
>>>> insurance companies will part with - successful vag hyst with
>>>> morcellation. Primary finding was major myometrial hypertrophy without
>>>> the multiple fibroids that were suspected. Great uterosacrals - so with
>>>> those incorporated into the vag closure - that apex just retracted right
>>>> up where you want it to be! She was doing quite well in the PACU when I
>>>> left the hospital.
>>>>
>>>> They should all go home early tomorrow. Around here the insurance
>>>> companies count a "23 hour" observation post op as an "outpatient" - I
>>>> like them being in the hospital in case they need antiemetics or other
>>>> attention in the evening or night. I had a very good friend from High
>>>> School sent home from PACU after a Vag Hyst (in Cincinnati) with a
>>>> catheter because she couldn't void. Nauseaus all night - was still
>>>> under the influence of anethesia drugs when given instructions for the
>>>> cath care. I think that is really not a good way to take care of
>>>> patients.
>>>>
>>>> --
>>>> Joanne Bulley, MD, FACOG
>>>> Solo gyn
>>>> Keene, NH USA
>>>>
>>>--
>>>R. Daniel Braun, MD FACOG(L) CMT
>>>Professor Emeritus
>>>Dept. of Obstetrics and Gynecology
>>>Indiana U. School of Medicine
>>>
>>>R. Daniel Braun
>>>
>>> "The way to health is an aromatic bath and scented massage
>everyday".
>>> Hippocrates
>>>
>>--
>>Garry E. Siegel, M.D.
>>Private Practice
>>Roswell, GA
>>
>--
>D. Ashley Hill, MD
>Associate Director
>Department of Obstetrics and Gynecology
>Florida Hospital Family Practice Residency
>Medical Director, Loch Haven Ob/Gyn Group
>Division Director, Dept. of Ob/Gyn, Florida Hospital Orlando
>Orlando, Florida
>
--
D. Ashley Hill, MD
Associate Director
Department of Obstetrics and Gynecology
Florida Hospital Family Practice Residency
Medical Director, Loch Haven Ob/Gyn Group
Division Director, Dept. of Ob/Gyn, Florida Hospital Orlando
Orlando, Florida
