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Re: LAVH ureteric injuryFrom: dahmd@gate.netSat May 4 22:57:26 1996
In article mccd@glen-net.ca (David McCoubrey) writes:
>I have had two recent ureteric injuries performing lavh with endoscopic We quit using the staplers because we had the same problem (misfired staples), with bleeding along the staple line. However, I was always taught not to staple the uterine artery, anyway, since the ureter "hangs out" too close and you could pull it into the staple line. I found the quote I remembered on this in a monograph on LAVHs by William Saye: "... in our opinion, application of the stapler below the uterine artery is sometimes risky". I remember reading somewhere that one way to reduce the cost of LAVH is to get the heck out of the abdomen as soon as you can, and go below. Taking the IP ligaments and maybe developing the bladder flap makes a lot of sense via the 'scope, but I'm not sure how taking the uterines adds anything (although I did see a video by Harry Reich where he vaginally morcellates a huge uterus after taking all the vessels laparoscopically--I think he used a needle and suture for the uterines). It sounds like you had some bad luck. Thanks, Ashley Hill D. Ashley Hill, M.D. Orlando, FL dahmd@gate.net
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