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Re: how to do a hysterectomy From: Richard Chudacoff (rchudacoff@mylinuxisp.com) Fri Dec 21 09:25:42 2007 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: art fougner, md: "Re: active tracing with decell" Previous message: Richard Chudacoff: "Re: active tracing with decell" In reply to: Joanne Bulley, MD: "Re: how to do a hysterectomy" Yet when I do an LSH I can pretty much tell adenomyosis from normal endometrium, so I don't totally discount someone with good hysteroscopic skills and experience, knowing the patient's history and examination, from deducing adenomyosis on hysteroscopy. -- Richard Chudacoff, MD, FACOG -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Joanne Bulley, MD Sent: Thursday, December 20, 2007 5:51 PM To: Multiple recipients of list OB-GYN-L Subject: Re: how to do a hysterectomy I don't identify it visually. If I am suspecting it by symptoms and exam, then if I am doing a hysteroscopy and she has completed childbearing, I use the resecting loop top get some myometrium and see what the pathologist says. So it is histology that ultimately identifies it, not the hysteroscopic findings. I have seen pictures from folks who say "this is how adenomyosis looks through a H/S" - and I think "yeah, and I am Santa Clause"! I hope that sounds a bit more sane! I try to be as certain as possible that there are not polyps and that the index of suspicion for adenomyosis is really low before suggesting global ablation for menorrhagia. I think if there is adenomyosis then you ought to give the whole uterus to the pathologist rather than do procedures such as ablations. Joanne At Thu, 20 Dec 2007, art fougner, md wrote: > >I'm curious about your finding adenomyosis at hysteroscopy ... that >sounds interesting in and of itself. > >Art > >At Wed, 19 Dec 2007, Joanne Bulley, MD wrote: >> >>This has been a great discussion (as someone else has said) >> >>I have done various of these parts. >> >>I learned in Ann Arbor to opn the anterior cul de sac first - when I >>moved her to Keene they were mostly doing the posterior first and that >>is what I nearly always do. I have often done the snake the index >>finger behind and over the broad ligament to show the anterior >>peritoneal reflection - but at times the uterus is too big. I like the >>suggestion to bend the uterine sound into a U and use it tin identify >>the anterior reflection. >> >>I have done plenty of morellations for the larger uterus. >> >>I have one coming up for someone who had had 3 or 4 C/S - but when I did >>her hysteroscopy and found adenomyosis - the uterus descended nicely and >>there seemed to be room - so we are going vaginally and some of these >>comments may help this old dog with some new techniques to have in the >>bag. >> >>Joanne >> >>-- >>Joanne Bulley, MD, FACOG >>Solo gyn >>Keene, NH USA >> >>More Snow on the Way! >> >-- >art fougner, md >"May The Wings of Liberty Never Lose a Feather." - Jack Burton > -- Joanne Bulley, MD, FACOG Solo gyn Keene, NH USA Next message: art fougner, md: "Re: active tracing with decell" Previous message: Richard Chudacoff: "Re: active tracing with decell" In reply to: Joanne Bulley, MD: "Re: how to do a hysterectomy"

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