Re: High uterosacral vaginal vault suspensions
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Sun Jun 29 11:34:52 2008
I am glad to know that I am in good company. I would love to hear a
more detailed description also.
Garry
At Fri, 27 Jun 2008, rchudacoff@mylinuxisp.com wrote:
>
>I'm not sure I understand the procedure. Can you describe it in slightly more detail?
>
>Richard Chudacoff, MD, FACOG
> -sent from my Treo 650
>
>-----Original Message-----
>
>From: Glen Elrod <dr99645@yahoo.com>
>Subj: Re: High uterosacral vaginal vault suspensions
>Date: Fri Jun 27, 2008 6:10 pm
>Size: 8K
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@mail.obgyn.net>
>
>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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>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
