One of the obvious benefits of a laparoscopic surgical approach compared to an open approach is less pain and morbidity related to smaller incisions and less wound morbidity. Postoperative pain in general is reduced with laparoscopic surgeries, but a unique type of pain is found in up to 80% of surgeries: post-laparoscopic shoulder pain (PLSP),…
Continue reading →Unfortunately, I’ve recently seen a rash of patients who have been told by other gynecologists that they suffer from a significant congenital uterine malformation that will require extensive workup, probable surgery, and will significantly hinder their ability to reproduce. Yet, in each case, the women either had no uterine abnormality at all or a mild…
Continue reading →When I talk to patients about weight loss, they usually tell me about their plans to exercise more and eat healthier. Recently, they ask me how I have lost 40 pounds or what magic I used to slim down. Most are sad to learn that there is no magic bullet. That being said, losing weight…
Continue reading →Stop the tilt I haven’t used a left lateral tilt during Cesarean delivery in years. There has never been any robust scientific data that tilting the table or tilting the mother with a rolled blanket or pillow to approximately 15° has any effect on fetal outcomes. Still, the practice is widespread and most practitioners believe…
Continue reading →From NPR. Did you see all the fuss about the recent Amelia Earhart documentary on the History Channel? A picture, found in the National Archives, purportedly shows Earhart and her navigator, Fred Noonan, sitting on a dock at Jaluit Atoll in the Marshall Islands with their plane sitting on a barge in the distance. This…
Continue reading →The Cesarean Delivery (CD) rate has dropped for a couple of years in a row now after increasing every year since about 1996. Cesarean delivery is associated with an increased risk of maternal death. Maternal death in the United States has been increasing since 1987, in tandem with the CD rate. Unnecessary Cesareans are now…
Continue reading →Complaints of vaginal irritation and/or vaginal discharge are very common in ambulatory settings, particularly in gynecology offices. Bacterial vaginosis, candidiasis, and trichomoniasis account for about 70% of these complaints. Patients who present with these symptoms are frequently over-treated and misdiagnosed. Those with recurrent symptoms are especially challenging. Here are four tips for correctly diagnosing women with…
Continue reading →The initial trocar placement at the time of laparoscopic surgery is the most important step: 50% of complications that occur during laparoscopic surgery occur with the initial laparoscopic puncture. Here are four tips to reduce the risk of injury when making the initial entry. 1. Use a direct entry optical trocar, preferably one that insufflates…
Continue reading →Postpartum sterilization is a relatively low-cost and convenient option for many women, but it is too often under-utilized because many obstetricians struggle with the technique. A postpartum tubal ligation should take about ten minutes, but for many surgeons it turns into an unnecessarily longer procedure as they struggle to locate the fallopian tubes. Here are…
Continue reading →Ever get an air knot? I bet you do, especially if you are a resident or early in surgical training. Air knots can cause major complications, particularly bleeding. They are sign of looser knots in general, and looser knots are more prone to delayed bleeding and knot failure, resulting sometimes in catastrophes like fascial dehiscence or even…
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