Re: acutely anteflexed uterus
From: D. Ashley Hill (dahmd@cfl.rr.com)
Sun Jul 22 15:08:07 2007
Nice job, Joanne. I have not used a flexible scope for the Essure
procedure.
Along the same lines as Joanne's story, I would like to share with the
group a "technique" I tried for the first time the other day out of
desperation. The patient is postmenopausal and had a failed attempt at
office hysteroscopy with endometrial sampling due to the worst stenosis
I have ever seen. Her internal os was about as big as the tip of a
ballpoint pen, so I did it in the OR. Even the half-step dilators were
too big to pass. Fearing a perforation, I placed the smallest half-step
dilator up to the pinpoint opening, then slid the smallest 30-degree
diagnostic hysteroscope I could find over the top of the dilator. I was
able to watch the dilator go into the opening, and was able to control
the depth of penetration so that it was only a few mm with each pass. I
did this sequentially until I could pass the laparoscope. No perf. I'm
sure others here have used this before, but perhaps someone can benefit
from my initial frustration. Have a nice weekend.
Ashley
At Sun, 22 Jul 2007, Joanne Bulley, MD wrote:
>
>Ultimately I did a combination of these suggestions.
>
>Weighted speculum definitely removed
>Drop the scope toward the floor
>pull like heck on the tenaculum - ripped out of the anterior lip several
>times
>put the tenaculum on the lateral lip and pulled and that seemed to alter
>the angle of the canal and in the scope went. (I didn't consider
>putting ant & post tenaculums as Ineeded to be able to drop that scope
>posteriorly.
>
>I was doing an essure and depsite taking 15 minutes to get in - the
>lining was not yet too edematous from the trials and I passed those
>essures into each tube easy as pie.
>
>Then I sutured the cervix.
>
>Has anyone put in any Essures with a flexible scope? (our hospital does
>tno have a flexible scope).
>
>So glad this was not one tried in the office!
>
>She wanted the sterilization - and had had a difficult cholecystectomy
>in the past with a umbilico=xiphoid incision - I thought avoiding the
>abdominal cavity was the best idea.
>
>Joanne
>
>At Fri, 20 Jul 2007, D. Ashley Hill wrote:
>>
>>I try to place the patient flat on the table (no T-berg), then place the
>>rigid hysteroscope into the cervix to the level of the internal os.
>>Then, drop your hand and 'scope as low as they will go (you may need to
>>remove the speculum if one is in place) and watch as you angle it
>>towards the fundus. Alternatively, a flexible scope may work. Good
>>luck.
>>
>>DAH
>>
>>At Fri, 20 Jul 2007, Joanne Bulley, MD wrote:
>>>
>>>OK folks - so I split the infinitive - anyone have any suggestions for
>>>dealing with the severely anteflexed uterus and successfully place the
>>>rigid hysteroscope into the uterus??
>>>
>>>Joanne
>>>
>>>At Fri, 20 Jul 2007, Raymond Stephen wrote:
>>>>
>>>>Well spotted, Gerald! Now I'm wondering how many others didn't notice the reversed order of the "to" and the "not"?
>>>>
>>>>Steve
>>>>
>>>>-----Original Message-----
>>>>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Gerald P.Rodriguez
>>>>Sent: Friday, 20 July 2007 1:19 AM
>>>>To: Multiple recipients of list OB-GYN-L
>>>>Subject: Re: acutely anteflexed uterus
>>>>
>>>>I think he was referring to the split infinitive that Joanne used; he was
>>>>not claiming it didn't come from the Bard.
>>>>
>>>>[After 25 years it was really bizarre having to try to guess how to get
>>>>into the cavity - while being exceedingly careful to not Perf!]
>>>>
>>>>Gerald P. Rodríguez, M.D., FACOG
>>>>Santa Fe
>>>>
>>>>>>>>>----- Original Message -----
>>>>From: "ainsron" <ainsron@sbcglobal.net>
>>>>To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net>
>>>>Sent: Thursday, July 19, 2007 8:49 AM
>>>>Subject: Re: acutely anteflexed uterus
>>>>
>>>>> If he didn't, who did?? If the quote isn't correct, correct it.
>>>>>
>>>>> "To be or not to be, --that is the question:--
>>>>> Whether 'tis nobler in the mind to suffer
>>>>> The slings and arrows of outrageous fortune
>>>>> Or to take arms against a sea of troubles,
>>>>> And by opposing end them?"
>>>>>
>>>>> -- From Hamlet (III, i, 56-61)
>>>>>
>>>>> Ronald E. Ainsworth, MD, FACOG
>>>>>
>>>>> -----Original Message-----
>>>>> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Raymond
>>>>> Stephen
>>>>> Sent: Wednesday, July 18, 2007 8:13 PM
>>>>> To: Multiple recipients of list OB-GYN-L
>>>>> Subject: RE: acutely anteflexed uterus
>>>>>
>>>>> Shakespeare did NOT write "to be or to not be"
>>>>>
>>>>> Steve
>>>>>
>>>>> -----Original Message-----
>>>>> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Joanne
>>>>> Bulley, MD
>>>>> Sent: Thursday, 19 July 2007 1:01 PM
>>>>> To: Multiple recipients of list OB-GYN-L
>>>>> Subject: acutely anteflexed uterus
>>>>>
>>>>> Hi Friends,
>>>>> "...while being exceedingly careful to not Perf!"
>>>>>
>>>>> --
>>>>> Joanne Bulley, MD, FACOG
>>>>> Solo gyn
>>>>> Keene, NH USA
>>>>>
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>>>>The information in this transmission may be confidential and/or protected by legal professional privilege, and is intended only for the person or persons to whom it is addressed. If you are not such a person, you are warned that any disclosure, copying or dissemination of the information is unauthorised. If you have received the transmission in error, please immediately contact this office by telephone, fax or email, to inform us of the error and to enable arrangements to be made for the destruction of the transmission, or its return at our cost. No liability is accepted for any unauthorised use of the information contained in this transmission. If the transmission contains advice, the advice is based on instructions in relation to, and is provided to the addressee in connection with, the matter mentioned above. Responsibility is not accepted for reliance upon it by any other person or for any other purpose.
>>>
>>>--
>>>Joanne Bulley, MD, FACOG
>>>Solo gyn
>>>Keene, NH USA
>>>
>>--
>>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
>>
>--
>Joanne Bulley, MD, FACOG
>Solo gyn
>Keene, NH USA
>
--
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
