Primun No Nocerumm
Three major surgeries today. A lot of instrument problems. I brought many of my own, but some disappeared after I handed them over to be sterilized. I did keep hold of my “titanium” scissors and clamps but lost (temporarily as it turned out) some retractors. Some surgery became more difficult.
As in Ecuador and the Philippines, ultrasounds are abundant and can be misleading, missing an advanced cancer last year. So I was wary when an ultrasound suggested hyperplasia (precancer) or even cancer itself, and proceeded with a vaginal surgery under the assumption that the uterus was enlarged and the bleeding abnormal because of benign fibroids. Wrong assumptions: at the best hyperplasia, a precancerous condition cured by the surgery; at worst, endometrial cancer that might have been spread by the technique I used ("morcellating" the uterus into small pieces, allowing the vaginal approach). Abdominal hysterectomy usually removes the uterus (and its cancer) intact.
So, did I do her a disservice by removing the (possibly) malignant uterus through vaginal instead of abdominal surgery?
'Do no harm' is tricky - jumping straight to the abdominal surgery only to find out afterwards that it wasn't necessary would have prompted similar second guessing, and would have included higher risk of complications and a more daunting recovery process. You made an educated guess, with experience and statistics on your side. Hoping for the best though - hyperplasia?
ReplyDeletehyperplasia is a diagnosis based on microscopic evaluation, no way to tell, there is no pathology dept: no one with microscopes or the equipment to prepare (stain) the speciments
ReplyDelete