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Re: GYN: Fibroids and a Pelvic KidneyFrom: Malcolm Griffiths (Malcolm@mgriff22.demon.co.uk)Wed Feb 25 15:26:41 1998
In message <34F4836D.4AA825E6@main.basec.net>, Gail Waldby <gwaldby@main.basec.net> writes >Really, Malcolm, you routinely take out 18 week uteri vaginally? Do you have >any tips and tricks to offer us? > I don't routinely, but I have taken them out upto 18 weeks size PV. Struck me that one of the problems her was hitting the kidney during an abdo op. Doing it PV would tend to bring the uterus out of the same field as the kidney and vag hyst tends naturallly to get the ureter and bladder out of the way. As far as taking big uterii out PV (took 14 weeker out PV this afternoon) my advice is: warn patient of risk of need for laparotomy don't book too much on list (I always break this rule) stick to basic principles until uterine Aa are controlled then consider either bissection, myomectomy (?multiple) or flipping the uterus over with cervix cephalad (either way) and thence attack the fundus (either by traction or by myomectomy approach to debulk. I have no personal experince of doing vag hyst in 18 w uterus and pelvic kidney, but it strikes me if you keep out of the pelvis, you should avoid the kidney! Other points (TIC): try to avoid regional anaesthesia make sure your anaesthetist doesn't give a combination of regional anaesthetic and vasodilators for anxiety/BP and then allow decompensated hypovolaemia - happened to me with a 22 weeker - she still went home 36 hrs post-op! Malcolm Griffiths MD,MRCOG,MFFP,Cert.Mgmnt Obstetrician & Gynaecologist Luton & Dunstable Hosp.,UK. Tel: 01582-497459 (office) Fax: 01582-497376 01525-222849 (home) email: Malcolm@mgriff22.demon.co.uk http://www.obgyn.net/board/griffith.htm "CLINICAL FREEDOM IS THE LAST REFUGE OF THE CLINICALLY INCOMPETENT!" (Someone [1997])
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