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Re: GYN: Fibroids and a Pelvic KidneyFrom: Marco A. Pelosi, III, MD (marcop@tao.agoron.com)Thu Feb 26 12:02:57 1998
At Wed, 25 Feb 1998, Gail Waldby wrote: > >Really, Malcolm, you routinely take out 18 week uteri vaginally? Do you have >any tips and tricks to offer us? > Gail, If you morcellate the uterus, size is irrelevant to the choice of surgical approach. 18-, 20-, even 24-week sized uteri are not difficult to remove transvaginally so long as you have uterine mobility and good vaginal exposure. The most useful advice I can offer is to start with a posterior colpotomy, then divide the uterosacral ligaments, then make the anterior cervico-vaginal incision, but mobilize the anterior vaginal epithelium only enough to get the bladder base off from the uterine arteries. Then go for the cardinals and the uterines, THEN go for anterior peritoneal entry, then begin morcellating. Don't become fixated with trying to open the anterior peritoneal fold at the outset. Administering GnRH agonists to shrink an 18+ week uterus is not likely to reduce its diameter very much and, in my humble view, is a waste of time. The only place for this adjunct is for the creation of temporary amenorrhea in anemic patients while hemoglobin stores are increased.
-- M.A. Pelosi, III, MD
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