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Re: Subtotal Laparoscopic HysterectomyFrom: dahmd@gate.netSun Mar 31 22:22:34 1996
In article Tilu Mangeshikar <tilprash@giasbm01.vsnl.net.in> writes: <cuts> >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. <cuts> 15-20 vag hysts per week...I'll bet there are residents reading your post who are looking into transferring to your program in India! (I remember a senior resident with a patient who was going to cancel her vag hyst to attend a church function. His comment: "Not even God is going to get between me and a vag hyst")! I agree that many gynecologists are overutilizing the laparoscope to make up for incomplete surgical skills. A contraindication to a LAVH should be the ability to do a "regular" vaginal hysterectomy. Techniques such as Lash myometrial coring, uterine bisection, posterior fundal myomectomy, etc., can help ensure a sucessful vaginal hysterectomy, without requiring the routine use of laparoscopy. I'm curious. By "tie and cut" do you mean simply stick tying around the vessel(s) and ligating them, then transecting between sutures (rather than the traditional clamping and then suturing)? Other than getting the clamp out of the way how does this change the surgery, and why would this decrease morbidity? It is possible to easily transfix the pedicles this way? For those interested in an excellent reference, I would suggest "The Difficult Vaginal Hysterectomy" (Springer-Verlag, 1995), by Mitchel Hoffman and William Spellacy, who taught me vaginal surgery and are two of the most extraordinary physicians I have ever met. It's a great text. (Thank you in advance for answering my questions). Ashley Hill (checking on flights to India) D. Ashley Hill, M.D. Orlando, FL dahmd@gate.net
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