While laparoscopic approach to ruptured ectopic requires extensive training, doing exploratory laparotomy approach is not much harder than C/S at all.
I have personally never performed a single C-Hyst in my life. However, while consulted by FP OB fellows in Memphis, we avoided C-Hyst a few times by B-Lynch, O'Leary's Stitch, and vigorously correcting accompanying DIC. Bakri balloon, sand bags are also useful in dealing with PPH. Those approaches for PPH are relatively easy to learn for FP fellows. My point here is: If we can avoid C-Hyst, we can minimize disatisfaction of patients and potential lawsuits.
I have also done a few TAH with OB fellows here. I am extremely satisfied by the surgical skills those fellows demonstrated: some are much better than average OB residents.However, without GYN or surgery backup, in emergency situation, supercervical hysterectomy is safer and easier than the whole TAH.
Bo Charles Li, MD, FACOG
Memphis, TN
I need to publicly thank Dr. Li who has been nominated for our "consutant hall of Fame"award. Dr. Li has been a wonderful teacher and deserves credit for the success of our fellows.
WMR
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