Re: How to do a hysterectomy
From: R. Daniel Braun (rd.braun@gmail.com)
Sun Dec 16 15:15:37 2007
I would usually enter posteriorly 1st, then take as many pedicles as needed
until it was easy to get in anteriorly. Once you get in post., there is no
urgency to get in anterior.
The last 15-20 that I did went home on the same day. Outpatient surgery.
Dan
On Dec 16, 2007 5:07 PM, <DoctorJoe@aol.com> wrote:
>
> In a message dated 12/16/07 3:52:56 PM, Stephen.Raymond@dhhs.tas.gov.auwrites:
>
> Because I open the peritoneum both anteriorly and posteriorly before
> taking any pedicles I am mystified by these posts that seem to specify one
> or the other. To me, both need to be opened, and not one or the other. Can
> you explain a little further? Are you talking about which you open first?
>
> There are a number of ways to "do" a vaginal hysterectomy.
>
> 1) Enter the posterior culdesac and enter anteriorly under the bladder.
> Then take your pedicles on each side "all the way up." If memory serves,
> this was called a Richardson. (Someone with a book out there, correct me if
> I'm wrong. It's kind of all coming back to me now. My old books were washed
> away in the Great Flood -- no, Katrina, not the Deluge! I'm not as old as
> Dan!)
>
> 2) Enter posterior only, take down the uterosacrals, then flip the uterus
> posteriorly and take the rounds and essentially work "down" from below.
> Ultimately, you can stick a finger over the top and find the plane under the
> bladder to enter anteriorly. This was called a Mayo, I believe.
>
> 3) Enter ANTERIOR only, flip the uterus anteriorly and perform a "normal"
> hysterectomy, essentially "from above," until you get down low enough to
> find your plane to enter (or exit) the posterior culdesac. This was a
> Doderlein-Koenig.
>
> Of course, classically NONE of these utilized that little tube with a
> lighted end that is so popular today. And a skilled GYN with a patient with
> "good" anatomy could "get it out" in about 20 minutes routinely. Nowadays,
> the patient could go home the next day, or 2 at the most. In fact, I'll bet
> you could do one of those "23 hour" admits with the support we have today.
>
> Joe P.
>
--
R. Daniel Braun, MD FACOG(L) CMT
Professor Emeritus
Dept. of Obstetrics and Gynecology
Indiana U. School of Medicine
R. Daniel Braun
"Science without Religion is LAME; Religion without Science is BLIND"
Einstein 1941
