Laparoscopic Hysterectomy with Removal of Ovaries - Part 3 of 4

[WarningFedz]

WTF IS THIS SHIT L0L? THIS SHIT IS DISQUSTING GF BITCHES BABIEZ DISLIKED NIGGY MAD?

[sugajarr]

hi Dr Kevin,

days before my period, i can feel a bump on my right ovary more visible when i am lying down. it disappears as soon as my period starts, is that normal? i also have high fever, shivering, lower back pain, wind, constipation and nausea. i'm 28 and African. my aunt died from ovarian cancer at 32 so i am always worried. thanks.

[drchinmay81]

is this a monopolar hook which you r using for cutting around vault... is harmonic more advisable for this sir?

[DrKevinStepp]

@drchinmay81 - I use monopolar hook on pure cutting current. I don't think there is any data that one technology is better than another for the colpotomy. The most important issue is to not damage the tissue excessively. That can happen to matter what energy source you use. Harmonic makes a bit less smoke, but gets very hot. Be careful while you are learning. Good luck.

[dr777666777]

why didn´t you remove the ovaries along with the uterus in one piece, i mean to do the cutting through the infundivulopelvic ligament during the hysterectomy so you wouldn't have to go back to remove the ovaries after doing the histerectomy, i think that would save a little time

[gynedoc]

Dr Strepp, Can you advise what diathermy settings you use for the monopolar hook?

Many thanks

[DrKevinStepp]

@gynedoc -- I usually start at 45 watts pure cutting (non-modulated) currrent. I don't use Coag (modulated) current for the colpotomy. I adjust the watts up or down as necessary to achieve the effect I need as each patient is different. If you have access to Covidien V-mode on their newer generators, that is nice... less smoke and more hemostatic.

[shane95670]

so 13 more days in the hospital and things seem to have settled down. although we still cant get her to eat any solid foods. is this common?

[DrKevinStepp]

@shane95670 Ugh! I'm sorry she is having such a rough time.  Hang in there. It is so difficult to comment on her actual case because with cancer surgery each case can be so different.... then throw in the kidney transplant and it gets even more complicated. My advice: support her through this difficult time and focus on the future.

[DrKevinStepp]

@shane95670 Ugh! I'm sorry she is having such a rough time. Hang in there. It is so difficult to comment on her actual case because with cancer surgery each case can be so different.... then throw in the kidney transplant and it gets even more complicated. My advice: support her through this difficult time and focus on the future.

[shane95670]

@DrKevinStepp our surgery went great!!!! HOWEVER, 2 days after surgery they discovered quite a large hematoma. they told her that it would go away on its own. but after releasing her from the hospital 3 days after the surgery ( open, by the way) i discovered that she wasnt "herself". thought it was just the pain killer. turned out that the hematoma caused an infection that her kidney could not fight off... ended up in her blood as well and was on the verge of complete renal failure.

[shane95670]

Ok thank you for your input... Also, watching your videos, makes me wanna see a video of how they will do hers. Very Very interesting! thanks for uploading this eries of 4.

[shane95670]

Dr Stepp,

My Girlfriend is scheduled for a Laparoscopic hysterectomy with everything completely removed. The problem is, she is the recipiant of a kidney transplant that is placed on the left side. will this ultimately be a problem and will she have to have the open surgery?

[DrKevinStepp]

@shane95670 -- Laparoscopic hysterectomy can certainly be done in this case. However, you need to make sure the surgeon is experienced - particularly with prior transplants. Hopefully she will be at a center where her transplant team can be around if needed. With her surgery, the anatomy can be challenging and there may be very little room for error. Let us know how she does...

[shane95670]

@DrKevinStepp Thanks Dr Stepp, the center she will be having this done is at UC Davis Med Center in Sacramento Ca. The surgeon will have her "helper" who is very experienced with the robot. However, the transplant team there is not my girlfriends transplant team. BUT the transplant Drs at UCDMC are among the best in Northern Ca

[shane95670]

@DrKevinStepp I also forgot to mention in the first message, that she was diagnosed with Uterine cancer in early March as well. And that it could have quite possibly spread to the lymph nodes. In this case, is Laparoscopic surgery still an option?? They are telling her no, and I fully trust the surgeons decision, but always better to have a 2nd opinion, especially in my girlfriends case.

[DrKevinStepp]

@shane95670 Hard to say for sure about her specific case. However, there are several centers that/who are removing uterine cancer and lymph nodes laparoscopically. Some will use the robot. Some don't need it. Each case is different however. Depends on what the nodes look like on CT Scans, where the new kidney is, etc. Hope that helps.

[EphsBrunette822]

what is a uterine manipulator? i just got diagonosed with PCOS andi have cysts all over my ovaries but for some reason surgery really isnt an option right now ...is there a reason for that? ...it puts me in alot of pain and i am 20 and shudnt have to go thru this

[DrKevinStepp]

A uterine manipulator is a surgical instrument we use in surgery to position the uterus or move it around.

Concerning your condition.. every patient is different.. Your doctor should help you understand the answers to your questions. If not, consider another opinion.

[sarahmark888]

Dr Stepp: are you using the RUMI+Koh cup here? I am using Vcare. RUMI+Koh is better in terms of delineating the cuff, but taking more time to put in. Any comments?

[DrKevinStepp]

I use Rumi/Koh or VCare. I agree completely with your comments. I think the VCare can be helpful with a very large uterus for manipulation all the way to the fundus.

[louisacomer]

I actually think this whole operation is amazing.. I am having mine in 6 weeks and its nice toknow what the consultant is actually going to be doing.

[DrKevinStepp]

BEST OF LUCK. let us know that it went fine...

[TheDiesel2009]

my grand ma died cause by metastases ovarian cancer, she has suffer for 4 to 6 months, ovarian cancer is a silent killer, you don't notice it, you feel its just a simple bloating in the stomach but it become dangerous, so its better go to doctor and have check up...you can notice it, is too late to cure...

[sfarsitul2012]

what is that ????its blue??

[DrKevinStepp]

Manipulator used to show the surgeon where to make the incision.

[ticovaldezmd]

KUDOS for posting the whole sequence in real-time. I can see this becoming a regular fare during Grand Rounds -- textbook-perfect. All the residents will surely enjoy this.

[BinkieMcFartnuggets]

That must smell awful...