Re: High uterosacral vaginal vault suspensions
From: R. Daniel Braun (rd.braun@gmail.com)
Sat Jun 28 09:06:30 2008
So did you ever look at one of the others through the scope? I have always
closed transversely, but I always tied the uterosacrals together.
Dan
On Fri, Jun 27, 2008 at 9:09 PM, Glen Elrod <dr99645@yahoo.com> wrote:
> Prior to moving here, I had routinely closed the cuff front to back, trying
> to incorporate the US at the angles. Here, I started to operate with a gyn
> that's dad was also a gynecologist and he has a unique closure that I hadn't
> seen before. Because he (and now I) use the Gyrus for all the vaginal
> pedicles, we don't have anything to tag going in. At the end of the hyst we
> use long Allis clamps to grasp the uterosacrals. We place 5 interrupted
> sutures starting just below the Allis clamp and going full thickness from
> peritoneum to vaginal mucosa. After the fifth one is placed it is tied.
> From that point, there is a small area anteriorly and posteriorly that is
> closed with a running suture of 0 vicryl.
>
> I wasn't sold on this closure until we did it during an LAVH and saw the
> great support at the cuff from the scope. Now that I've done some and seen
> them back for 6 week checkups, the cuff seems long, well supported and very
> anatomic.
>
> Glen
>
>> ----- Original Message ----
> From: Raymond Stephen <Stephen.Raymond@dhhs.tas.gov.au>
> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@mail.obgyn.net>
> Sent: Saturday, June 21, 2008 4:59:05 PM
> Subject: RE: High uterosacral vaginal vault suspensions
>
> That is the way I was taught in the 70s and have done ever since. It seems
> I am the only one doing it here, and the registrars are impressed. I am
> sure it helps vault support.
>
> Steve
>
> ------------------------------
> *From:* ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] *On Behalf Of *Charlie
> ------------------------------
> Chambers
> ------------------------------
> *Sent:* Sunday, 22 June 2008 8:11 AM
> *To:* Multiple recipients of list OB-GYN-L
> *Subject:* Re: High uterosacral vaginal vault suspensions
>
> With vag hyst my partner hangs on ties around/through the cardinal or the
> USL. At the time of closure, he ties them together in the midline w/ the
> corresponding ties that were tagged. He feels this gives the cuff additional
> support. What says the forum?
>
> ****************************************************************************
>
> Charlie Chambers
>
> Hood River, OR USA
>
> cchamber@alumni.rice.edu
>
> "...not because I regard fishing as being so terribly
>
> important but because I suspect that so many of the other
>
> concerns of men are equally unimportant-and not nearly
>
> so much fun."
>
> John Voelker
>
> *****************************************************************************
>
> On Jun 21, 2008, at 2:39 PM, Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.
> wrote:
>
> At Sat, 21 Jun 2008, rchudacoff@mylinuxisp.com wrote:
>
> Grab the US with a Babcock clamp as high as you think necessary (palpate
> the ureter to make sure you grab the right thing). Come laterally through
> the vaginal epithelium-US-cardinal ligament complex, throw two times above
> the Babcock (make sure you don't go through the Babcock clamp) and then come
> out posterior on the ipsilateral side. Hold with a hemostat. After you close
> the cuff tie down and watch the cuff elevate. I use O Vicryl but some use
> Ethibond. I just don't want the permanent suture in the vaginal. I have only
> pinched the ureters once. Cysto with Indigo Carmine might be a good idea for
> your first few cases
>
> Richard Chudacoff, MD, FACOG
>
> -sent from my Treo 650
>
> Now do that vaginally, yes it can be done vaginally, not exactly as
> Richard described but the same general idea.
>
> --
> Take care, John
>
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--
R. Daniel Braun, MD FACOG(L) ABMP CMTh
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
