Here we are again - it's hard to believe it's been a whole week since I last wrote. Two wonderful things happened in the past week - someone actually posted a comment so I know at least 1 person is reading this (thanks!), and more importantly, I did my first case here in Bend. Dr Redwine talked me through my first laparoscopic lymph node dissection. For those of you, probably most, who don't know what this is, it's a procedure only recently adopted by most oncologists for staging cancers of the uterus. You may be thinking, 'well what the heck does this have to do with endometriosis? I don't have cancer.....', and there is an answer to that question. The laparoscopic lymph node dissection is actually the perfect case to learn the deep retroperitoneal pelvic anatomy. This is the part of the pelvis where 99% of general gynecologist never go. It is also where we go quite frequently in the pursuit of invasive endometriosis, and in those cases the anatomy isn't always normal or easy to navigate through, so this was actually a great learning case. More importantly, Dr. Redwine was pleased and impressed with the way we operated together. Plus, I'm showing him a few new tricks that were invented in the 21st century....

The other fun thing I did in the past week was go to Seattle to watch a laparoscopic sacrocolpopexy. This is a procedure done laparoscopically in only a handful of locations around the country, but regardless of the approach (open or laparoscopic) it is the best way to resupport the top of the vagina after it falls down. I've been doing sacrocolpopexies open for many years, and now we will be doing them through the scope, which allows the patient to recover a lot faster than if she has a big incision, as the incision is the part that hurts the most and limits activity the most. A mesh is sutured to the upper vagina, then sutured to the sacrum (the bone at the base of the spine). This procedure gives stronger support and a longer vagina than do most vaginal approaches to apical descent. It also allows better sexual function after the repair, so for most women in their 50s and 60s, it is the ideal surgery for repairing that stubborn nasty prolapse. Sometimes I wake in my sleep and hear vaginas around the world calling "help I've fallen and I can't giddy up....."
But seriously, I'm really excited about how my 2 passions, endometriosis surgery and pelvic prolapse surgery are dovetailing. The joy of helping women return to their normal lives comes from both types of surgery, and the surgical challenges, understanding the anatomy, and doing everything with the most minimally invasive techniques are nothing new to me. Nonetheless, being here and getting to operate with Dr. Redwine is exciting and fulfilling and challenging all at once, and I love it.
Well, I'm off to the hospital for more fun and excitement.
See ya next week, and a hui ho.....