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Re: Subtotal Laparoscopic Hysterectomy From: Tilu Mangeshikar (tilprash@giasbm01.vsnl.net.in) Sun Mar 31 21:18:51 1996 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Tilu Mangeshikar: "Re: Subtotal Laparoscopic Hysterectomy" Previous message: David Nagey: "Re: VBAC after c/s x5" Maybe in reply to: ENDODOK@aol.com: "Subtotal Laparoscopic Hysterectomy" Next in thread: Tilu Mangeshikar: "Re: Subtotal Laparoscopic Hysterectomy" Dear Dr. Stewart, A laparoscopic approach at the outset,(LAVH) does not make a vaginal hysterectomy any easier; that is, it does not facilitate further descencus of the uterus so as to assume that the vaginal part of the LAVH would be easy after laparoscopic intervention. In fact what LAVH seems to have done to "Not so skilled" vaginal surgeons is that it has made them more ambitious to deliver the uterus vaginally. Sharpening one's skills at vaginal surgery would help avoid the use of laparoscopy in most cases. At our center, even non-descent uteri usually do not require either LAVH or abdominal hysterectomy. My senior consultant Dr. PB Pai Dhungat performs approx. 15 to 20 vaginal hysterectomies per week, the avg operating time is 40 minutes, 95% of the uteri have no prolapse, the blood loss is minimal. We do not use clamps rather "tie and cut" the pedicles; this has been the reason for low morbidity (Dr. Pai Dhungat's opinion over the last twenty years). We discharge our patients now within a day or two after surgery. We reserve LAVH only in 3% of our patients to release adhesions or endometriosis. Another 5% of our patients are scheduled directly for abdominal hysterectomy for obvious reasons. We look forward to redefine LAVH in the future as "Local Anaesthesia Vaginal Hysterectomy" At 16:58 31/03/96 -0600, you wrote: >Stewart: There are many gynecologists in this country who favor SLH over >LAVH. Harry Hasson in Chicago, and Tommy Lyons in Atlanta are two >enthusiastic proponents citing faster operating times, fewer complications >(ie cuff not opened) and better post-operative support to the vault. Better >sexual function has been also raised as a reason for consideration of SLH, >although I'm not sure how one can realistically arrive at this conclusion. >The biggest impediment I believe for most surgeons is the inherent >difficulties (for many docs) with rapid suturing; an essential technique but >it does take much practice to master. LAVH allows the vaginal route to be >successful in most cases, and vaginal hysterectomy is a gynecologist's bread >and butter! > Dr. Prashant Mangeshikar Consultant Gynecologist and Endoscopic Surgeon Bombay Hospital & Institute of Medical Sciences New Marine Lines Bombay Tel No 0091-22-3680168 EMail: Tilprash@giasbm01.vsnl.net.in > -- Tilu Mangeshikar MD,DA,FRCA Intensivist. Bombay Hospital. Tel: 91 22 3680168 Add: Madhav Niwas, 8 Laburnum Rd. Gamdevi Bombay 400007. India Next message: Tilu Mangeshikar: "Re: Subtotal Laparoscopic Hysterectomy" Previous message: David Nagey: "Re: VBAC after c/s x5" Maybe in reply to: ENDODOK@aol.com: "Subtotal Laparoscopic Hysterectomy" Next in thread: Tilu Mangeshikar: "Re: Subtotal Laparoscopic Hysterectomy"

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