Melody T. McCloud, MD
Atlanta, Georgia
Dr. Barbieri responds
I appreciate the pearls provided by Dr. Sacks, Dr. Michael, and Dr. Graebe. We thank them for sharing their clinical expertise with the OBG Management community.
As Dr. McCloud reports, a severe shoulder dystocia is a particularly frightening event, forever etched on the memory of the obstetrician. As she attests, a quick response involving a relentlessly rehearsed series of interventions calms the nerves and is the secret to successful resolution of this obstetric emergency.
The robot is unnecessary for benign hysterectomy
The physicians in my practice work in a 210-bed hospital in a sparsely populated state. We don’t have the privilege of using a robot for surgery, so we began performing total laparoscopic hysterectomy (TLH) without the robot about 3 years ago. A few of our earlier cases took as long as 3 hours to complete, but we now are able to perform TLH on almost any benign condition in 30 to 90 minutes.
We have avoided the need to convert to open laparotomy in more than 100 consecutive cases, and have performed TLH in uteri as large as 850 g, as well as in women with stage 4 endometriosis.
The partners in my practice who perform TLH did not find the procedure difficult to learn. Even with laparoscopic suture closure of the vaginal apex, we feel that the robot is unnecessary for laparoscopic hysterectomy for benign conditions.
Our overall abdominal hysterectomy rate for the past 5 years is about 12%, by the way.
Philip Wagner, MD
Cheyenne, Wyoming