Re: How to do a hysterectomy
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Wed Dec 19 09:39:17 2007
I have not tried this with the laparoscope, but it sounds easy, but what
do you do about distention?
Billing? Included at one low price :).
Garry
At Wed, 19 Dec 2007, R. Daniel Braun wrote:
>
>The main purpose of the cystoscopy is to detect the ureteral injury while
>the patient is still asleep and on the table, so that it can be repaired
>then. Usually takes about 5 minutes or less, and really doesn't need any
>dye. Indigo carmine is preferred over methylene blue if you feel the need to
>use it. If going to use dye, inject 5-10 minutes before starting the cysto.
>
>Dan
>
>On Dec 19, 2007 10:40 AM, Henry Gregor <henrygregor@yahoo.com> wrote:
>
>> I see where that would work well, with your doing the studies and the
>> comparisons. If you have a patient in hopsital inpatient status, can you
>> still do the postop sonos at bedside, w/o turf battles with the
>> radiologists? (Obviously postop studies done in your office would not have
>> this issue.)
>>
>> Trust....operative word, isn't it? Great when docs have it. Sad, when they
>> don't. Have you ever read an American comic strip called "Pogo"? Pogo had a
>> great line, "We have met the enemy, and he is us"...unfortuanately, over the
>> years that sometimes characterizes how some folks don't get along for their
>> mutual benefit.
>>
>> Hank
>>
>> *Dr Eberhard Lisse <el@lisse.NA>* wrote:
>>
>> Hank,
>>
>> I do the sonars myself. Pre- and Post-Op. No problem whatsoever.
>> I also do them at ANC and pick up quite a number of pregnancy
>> related hydronephroses. I work with one particular Urologist
>> and we have come to trust each other :-)-O
>>
>> el
>>
>> on 12/19/07 9:15 AM Henry Gregor said the following:
>>
>> > Interesting approach. Seems time intensive, with the preop study
>> > (Is it done on everyone?) and then it seems multiple postop
>> > clinical assessments involving a decision to repeat ureteral
>> > sonongraphy or not, and then in some (I assume it would only be a
>> > few) another sono assessment and comparison of urereteral dimensions
>> > pre and post op....I'm thinking now of how many times a comparison
>> > could elicit a radilologic interpertation that weazles and waffles a
>> > bit, ending with one of those phrases suggesting correlating to
>> > clinical status, consider 24 f/u study, consider MRI, CT w/contrast,
>> > etc., etc.
>> >
>> > I don't cysto every patient, and don't know anyone who does, but
>> > where a dissection or an anantomic procerss (such as fibroid down by
>> > the LUS or cx or broad ligament, or bulbous cx presents) it's a
>> > reasonable clinical call to do one. While it does make for a better
>> > sleep for the surgeon, my earlier comments were tongue in
>> > cheek...where the clinical condition raises some concern, then its
>> > certainly for the patient's benefit as well. If I were a patient
>> > with a problem, I'd rather wake up in the PACU stented and/or
>> > otherwise corrected as opposed to waiting.
>> >
>> > That said, in the case of a postop hematoma, that's obviousle going
>> > to be a post op care evaluation, and not in the least influenced by
>> > a cysto in the or at completion of hys'y.
>> >
>> > Hank
>> >
>> > */Dr Eberhard W Lisse /* wrote:
>> >
>> > Routine cystoscopy? PULEEZE!
>> >
>> > The MPS (the predominant Malpractice Carrier in the
>> > Commonwealth) suggests having a routine post op checkup in
>> > place, ie Ultrasound, perhaps on day 5. Preferably with one
>> > before the operation to compare. That'll show hydronephrosis,
>> > and you have sufficient time for the Urologist to do her thing.
>> >
>> > Served me well, when one of my patients developed a haematoma on
>> > the right side. We saw it waited another day when the
>> > hydronephrosis had increased, and we took her to the Operating
>> > Theatre where my colleague stented her easily.
>> >
>> > The results were dramatic, the patient is very happy. The
>> > priceless moment was when she said: "Is this what you explained
>> > to me at the consent?"
>> >
>> > On expected difficult pelvic anatomy, previous bladder surgery
>> > and such like, and/or if I ask the Urologist to come to the
>> > table, I have both urethers stented, after during one case the
>> > Urologist casually opened the bladder, put in a small feeding
>> > tube and only then could palpate the ureter.
>> >
>> > I do not think there is a place for chromic any more, in
>> > particular since there is rapidly dissolving vicryl.
>> >
>> > On Dec 19, 2007, at 04:03, Joe wrote:
>> >
>> > > Steve, I humbly suggest that your legal system is a bit different
>> > > than ours. Joe C
>> >
>> > el
>> >
>> > Search.
>> >
>>
>> >
>>
>> --
>> Dr. Eberhard W. Lisse \ / Obstetrician & Gynaecologist (Saar)
>> el@lisse.NA el108-ARIN / * | Telephone: +264 81 124 6733 (cell)
>> PO Box 8421 \ / Please do NOT email to this address
>> Bachbrecht, Namibia ;____/ if it is DNS related in ANY way
>>
>--
>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
>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
|
|
