#Hysteroscope

[ethanleonel]

Experience Advanced Scarless Surgery by Dubai’s Top Gynaecologist

Dr. Usha Kiran Talakere holds the position as one of the top Obstetrician-Gynecologist in Dubai UAE, having more than twenty years of experience, with specializations in Minimally invasive surgery and advanced laparoscopy and hysteroscopic procedures; she remains the first vNOTES Scarless surgeon in the United Arab Emirates.

Scarless Surgery Advanced Specialties

Dr. Usha Kiran is an expert in the fields of Level 3/4 Advanced Minimally Invasive Laparoscopic Surgery and Hysteroscopic Surgery. She provides treatments like excision of endometriosis, removal of fibroids, tape procedures transobturator for restoration of incontinence and urogynecology treatments for pelvic health and the correction of prolapse. This helps women to achieve new, minimally invasive methods of comfort and health repair.

[dr-sukhamoy-barik]

Ways to prepare for your hysteroscopy

Preparing for a hysteroscopy, a procedure to examine the inside of the uterus, can help ensure optimal results. Here are some practical steps by the best hysteroscopic surgeon to help you prepare for the procedure. 

How to prepare for a hysteroscopy?

1. Understand the Procedure: Before the procedure, take time to understand what a hysteroscopy involves. Your doctor will use a hysteroscope, a thin tube, to view the inside of your uterus.

2. Discuss with Your Doctor: Have a detailed discussion with your doctor about what to expect. This is the time to ask questions and clarify any doubts you may have.

3. Follow Pre-Procedure Instructions: The best hysteroscopic surgeon will provide specific instructions to follow before the procedure. These may include:

Fasting: You might be asked not to eat or drink for a certain period before the procedure, especially if you are having general anesthesia.

Medications: Inform your doctor about any medications you are taking. You may need to stop certain medications before the hysteroscopy.

Menstrual Cycle: Schedule the procedure when you are not menstruating. The best time is usually after your period ends and before ovulation.

4. Prepare for Anesthesia: Depending on the complexity of the hysteroscopy, local, regional or general anesthesia may be used. Your doctor will discuss the kind of anesthesia and how to prepare for it.

Conclusion

By being well-prepared, you can have a smoother experience and a quicker recovery. Consult with the best hysteroscopic surgeon for the best outcomes.

[drasmitadongare]

Best Gynecologist in Aundh| Female Gynecologist in Aundh| Best Lady Gynecologist in Aundh : Dr. Asmita Dongare

If you’re facing gynecological issues and living in Aundh, Pune or nearby areas then your search for the Best Gynecologist in Aundh ends here. With 15 years of extensive experience, Dr. Asmita Dongare is a compassionate and empathetic Obstetrician and Gynecologist in Aundh, Pune.

[drsukhamoybarik]

The highly certified and experienced hysteroscopic doctor in Dum dum uses state-of-the-art technology in examining patients and achieving success.

[healthify2u]

Hysteroscopic Myomectomy in Dubai | Dr Pranjali Singh

Hysteroscopic Myomectomy in Dubai, performed by the skilled hands of Dr. Pranjali Singh, offers a beacon of hope for women grappling with uterine fibroids. Uterine fibroids, though benign, can cause pain, heavy bleeding, and fertility issues. Dr. Singh's expertise in hysteroscopic myomectomy, a minimally invasive procedure, ensures a swift recovery and minimal scarring. Her dedication to women's health and state-of-the-art technology at Dubai's renowned medical facilities make her a sought-after specialist.

Patients trust Dr. Pranjali Singh for her compassionate care and commitment to their well-being. If you're seeking a solution to uterine fibroids in Dubai, her hysteroscopic myomectomy services provide a path to a healthier, fibroid-free future.

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[drnehalalla]

Is hysteroscopic myoma resection suitable for everyone?

Hysteroscopic myoma resection may not be suitable for everyone, and its appropriateness depends on various factors. Here are considerations regarding the suitability of hysteroscopic myoma resection:

Fibroid Type and Location: Most effective for submucosal fibroids.

Size of Fibroids: Larger fibroids may pose challenges.

Number of Fibroids: Suitable for a limited number; extensive cases may need alternatives.

Uterine Shape and Size: Feasibility depends on the uterus's shape and size.

Patient's Overall Health: Certain health conditions may impact suitability.

Desire for Fertility: Recommended for fertility preservation; discuss with a healthcare provider.

Prior Surgeries: Past uterine surgeries can influence safety and feasibility.

Patient Preferences: Individual comfort and preferences play a role.

Before hysteroscopic myoma resection, consult your healthcare provider for a thorough evaluation. The decision considers fibroid characteristics, overall health, and treatment goals. Alternative options may be recommended based on individual circumstances. Always consult with your healthcare provider for the most appropriate treatment plan.

For top-notch gynecological care in Dubai, look no further. Schedule a consultation with Dr. Neha Lalla, an expert Gynaecologist in Dubai. Experience specialized and compassionate women's health services. Book your appointment today.

[rituivf]

The Promise of Fertility Enhancing Surgery

Discover how Fertility Enhancing Surgery opens new avenues for prospective parents. Explore its potential to overcome fertility challenges and make parenthood dreams a reality. Delve into the innovative procedures that offer hope, empowerment, and a brighter path toward creating a loving family. For More Info: Fertility Enhancing Hysteroscopic Surgery

[gynecologyhospital]

Understanding Hysteroscopy: A Minimally Invasive Diagnostic and Therapeutic Procedure

Hysteroscopy is a revolutionary medical procedure that has transformed the way gynecological conditions are diagnosed and treated. It offers a minimally invasive approach, providing numerous benefits to both patients and healthcare providers. In this article, we will delve into the world of hysteroscopy, exploring its purpose, procedure, and the advantages it brings to women’s healthcare.

What is Hysteroscopy?Hysteroscopy is a medical technique that involves inserting a slender, lighted instrument called a hysteroscope into the uterus through the vagina and cervix. This enables direct visualization of the uterine cavity, allowing for accurate diagnosis and treatment of various conditions. It is typically performed on an outpatient basis and is considered a safe and effective procedure.

Benefits of a Minimally Invasive Approach:One of the significant advantages of hysteroscopy is that it is minimally invasive, meaning it requires only small incisions or no incisions at all. This leads to reduced pain, shorter recovery time, and minimal scarring compared to traditional open surgeries. It also lowers the risk of complications and allows for a quicker return to daily activities.

Diagnostic Hysteroscopy:Hysteroscopy plays a vital role in diagnosing various gynecological conditions. It provides a clear view of the uterine cavity, allowing the healthcare provider to identify abnormalities such as polyps, fibroids, adhesions, or structural issues. With hysteroscopy, precise biopsies can be taken, and tissue samples can be obtained for further evaluation.

Therapeutic Hysteroscopy:Not only is hysteroscopy diagnostic, but it is also therapeutic. It offers the opportunity to treat certain conditions directly during the procedure. For example, polyps or fibroids can be removed, adhesions can be released, and abnormal tissue can be excised. Hysteroscopy enables targeted interventions, reducing the need for more invasive surgeries and promoting optimal patient outcomes.

Advancements in Women’s Healthcare:Hysteroscopy has brought about significant advancements in women’s healthcare. It has revolutionized the management of conditions such as abnormal uterine bleeding, infertility, endometrial abnormalities, and uterine malformations. The procedure allows for precise and tailored treatments, improving patient satisfaction and quality of life.

Patient Experience and Recovery:Patients undergoing hysteroscopy often report a positive experience. The procedure is usually performed under anesthesia or conscious sedation, ensuring patient comfort. Recovery is typically quick, with minimal discomfort and a short hospital stay, if any. Within a few days, the majority of people are able to return to their normal activities.

Conclusion:Hysteroscopy has emerged as a valuable tool in the field of women’s healthcare, providing a minimally invasive approach to diagnosis and treatment. Its ability to visualize and address uterine conditions with precision has transformed the management of various gynecological issues. As advancements continue to be made, hysteroscopy promises even better outcomes for women worldwide, empowering them with improved health and well-being.

[jcrmhscasereports]

Massive volume overload with severe pulmonary edema during hysteroscopy: a case report by F.Fiedler in Journal of Clinical Case Reports Medical Images and Health Sciences  

INTRODUCTION

One of the most serious problems of therapeutic hysteroscopic procedures nowadays depending on a distending media in use, remains a fluid overload with concomitant electrolyte imbalance. This rare but very life threatening condition remains of great concern and requires interdisciplinary management from experts of different fields such as anesthesiology, intensive care, cardiology and nephrology.

The irrigating media plays an essential role during hysteroscopic operations because it distends a uterine cavity and so provides a necessary visibility. There are gasous and liquid types of media. The Carbon dioxide is obsolete because it provides insufficient visibility and can lead to severe complications such as embolism or systemic accumulation due to its high solubility.

The liquid ones vary according to their osmolality, viscosity and electrolyte content, respectively an overload can cause different kinds of pathological settings.

Depending on the type of current (monopolar vs. bipolar) the irriganting fluid may or may not content electrolytes. The electrolyte-free, low-viscosity fluids, such as Mannitol/ Sorbitol mixture, Glycin 1,5%, Glucose 5%, Sorbitol 3%  are standard media in monopolar surgery. The excessive absorption can lead to a hypoosmolal  hyperhydratation (also known as transurethral resection syndrome of prostate in urology patients) resulting in severe overload and dilutional hyponatriaemia, which can be a cause of different neurological clinical sequelae such as grand-mal-seizures and cerebral edema up to a brainstem herniation.

The isotonic solutions such as NaCl 0,9% or Ringer-Lactat on the other hand, are golden standard in bipolar hysteroscopic procedures and its systemic absorption can cause an isoosmolal hyperhydratation associated with hyperchloremic acidosis and pulmonary edema up to acute respiratory distress syndrome.

In this case report we will describe a particular clinical setting of excessive fluid overload with severe pulmonary edema in a 38-years-old female after a hysteroscopy and resectoscopy.

PATIENT’S MEDICAL HISTORY

38-years-old black woman, 55kg, presented herself for a hypermenorrhea caused by multiple submucous and intramural myomas. Due to longlasting, intense bleedings she developed iron-deficiency-anemia with hemoglobin level of 8,8g/dl. The anemia has been treated with iron infusions, vitamin-B12 and folic acid. However she was well adapted and didn’t show tachycardia or any kind of anemia- related symptoms.

Further on she suffered from infertility most likely caused by Uterus myomatosus, which had been previously treated by hysteroscopic and laparoscopic myomectomy.

Further preoperative assessment revealed an occasional smoker but otherwise healthy patient and routine laboratory analysis were unremarkable except for earlier mentioned anemia. The previous general anaesthesias were uneventful and she was classified as ASA II- patient. The premedication consisted of 7,5mg Midazolam p.o.

THE PROCEDURE AND INTRAOPERATIVE SETTING

After the general anesthesia has been inducted, consisting of 200mg Propofol, 0,2mg Fentanyl and 6mg Cisatracurium, patient was intubated uneventfully. A single-shot-antibiotic with 2g Cefazolin was administered before surgical start. Further anaesthesia was maintained with Sevoflurane (endexpiratory concentration 1,2 vol%) during low-flow-volume-controlled-ventilation.

The hysteroscopy was performed with a physiological saline solution as a distending medium administered by Karl Storz Hamou Endomat pump in hysteroscopy modul within preselected pressure- (max.150mmHg) and flow- range (max.400ml/min). The resectoscope had an active suction channel and myomectomy was facilitated with bipolar current.

After a resection time of 35 minutes the operating procedure became complicated due to big intracavitary myomas, consequently a larger amount of distending media was required to keep the visibility during the hysteroscopy. The efflux of the irrigating fluid wasn’t monitored because of the high amount lost in the sterile drapes.

In the meantime the patient developed mild tachycardia with descrete ST-depressions, that disappeared after deepening the anaesthesia. Further on she developed high respiratory pressures and the accurate examination of the patient lying in Trendelenburg position and in a dark operating theatre revealed swollen face that was missinterpreted as Quincke-edema and immediately treated with 4mg Dimetinden, 50mg Ranitidin and 500mg Prednisone.

The immediate termination of the procedure revealed a general swelling of a patient especially in abdominal and facial region. The uterus perforation was denied by the gynaecologist but due to threatening abdominal compartment syndrome an urgent laparoscopy was preformed, which revealed 2,5l of intraabdominal fluid. At that point the gynaecologist declared 9l deficit between the in- and outflow of the irrigating fluid.

Meanwhile the ventilation was severly impeded by massive pulmonary edema and 1,5l clear fluid was suctioned from the endotrachal tube. The oxygen saturation dropped to 53% and the inspiratory peak pressure reached up to 60 mmHg. The diuresis was stimulated by 80mg furosemid.

Under full mechanical ventilation support with high positive endexpiratory pressure and analgosedation we transferred the patient to the ICU.

ICU-MANAGEMENT

By the admission to the ICU the arterial blood gas analysis revealed

pH 6,95

pO2 92,2 mmHg

pCO2 58 mmHg

SO2 87%

HCO3 12,7 mmHg

BE -17,8 mmHg

Hb 6,5 g/dl

K+ 2,9mmol/l

Na+ 142 mmol/l

Lactat acid 4,27 mmol/l

The combined (hyperchloremic and respiratory) acidosis reached it’s peak later, when HCO3 dropped to 6,9 mmHg and was treated aggressively by 200mg HCO3 8,4%. The potassium substitution was administered via central venous line.

Noradrenaline was used to stabilize the circulation and the volume therapy was monitored with invasive hemodynamic monitoring (PICCOR), which revealed hypovolemia (GEDI 444 ml/m2) and pulmonary edema (ELWI 13 ml/kg) despite sufficient systemic vascular resistance (SVRI 3949 dyn*s*cm-5*m2) and good pump function (Cardiac Index 3,34 l/min/m2).

The 30,6 C° body temperature was treated with an active warming system for the next 18h until the normal temperature was reached.

The intraabdominal pressure was measured by bladder pressure monitoring (14 mmHg).

The oxygenation increased with forced diuresis and positive endexpiratory pressure ventilation (12 cmH2O).

Figure 1: Chest X-ray reveals pulmonary edema after ICU admission

After 24h of fully controlled mechanical ventilation and 6800ml of diuresis the sedation medication was terminated and the patient extubated uneventfully. No further ventilation support or vasoactive medication was required. The patient recovered in the matter of 72 hours and was discharged from the hospital on the day 7 with a mild arterial hypertension, that was treated by Hydrochlorthiazide 25mg a day.

DISCUSSION

 The isoosmolar hyperhydratation due to massive absorption of irrigating fluid, also known as Operative Hysteroscopy Intravascular Absorption Syndrome (OHIA)  is a life threatening complication of the bipolar resectoscopic procedures.

There are three different manners the distending fluid can be absorbed:

the fluid instillation in peritoneal cavity via fallopian tubes causing a high amount of free abdominal fluid, which can lead up to an abdominal compartment syndrome

 the absorption via endo- and myometrium causing a massive subcutan fluid overload

the intravascular absorption due to exceed of the venous vascular pressure of  endometrium by an irrigating fluid pressure causing expansion of plasma volume and consequently intravascular fluid overload.

This case report shows a massive absorption of distending fluid mostly throughout the endometrium causing generalized and later on pulmonary edema and throughout fallopian tubes causing acute abdomen. The delayed diagnosis of this complication was due to unreported imbalance between the irrigating fluid instilled (12 litres) and the volume recovered (3 litres) from the patient. Other conditions that impeded the early diagnosis were darkened operating theatre because of the hysteroscopy and Trendelenburg position of the patient, fully covered in warm sheets in order to prevent hypothermia.

The threatening abdominal compartment was promptly treated by an urgent laparoscopy and the patient responded very well to a complex symptom-orientated intensive care therapy. A mild arterial hypertension is a residual symptom of a massive NaCl-absorption and respectively delayed sodium and water excretion and is expected to disappear within days.

The top priority is the prevention of the excessive absorption and once this complication occurred, its rapid, correct diagnosis as well as early-goal-therapy is essential. The fundamental knowledge of different distending media and its possible complications must be considered by the gynecologist and anesthesiologist. Once the distending medium has been determined, certain strategy must be applied in order to avoid the massive fluid overload. The exact amount of administered and removed irrigating fluid must be accurately monitored, which can be impeded be different factors such as spilling the media on the floor or in sterile sheets, not exact amount of media in the bag (varies up to 5%), difficult estimation of not-used fluid in the bag. The irrigation pressure limit should be lower then the mean arterial pressure whenever possible and complicated operative procedures that take longer time such as myomectomy require splitting in two sessions.

As soon as the difference of instilled and recovered amount reaches the limit, that should be set a priori or a patient starts showing symptoms, the measurement of electrolytes, osmolality and arterial blood gasses should be preformed and the procedure terminated as soon as possible.

For more information: https://jmedcasereportsimages.org/about-us/

For more submission : https://jmedcasereportsimages.org/

[partoftheairforce]

i’m getting freaking hysteroscopic surgery today i’m shitting my pants

[myhealthhospital]

What are complications of hysteroscopy?

Hysteroscopy is a medical procedure that involves examining the inside of the uterus using a thin, lighted tube called a hysteroscope. It is commonly used for diagnostic and therapeutic purposes. While hysteroscopy is generally considered safe, like any medical procedure, it carries some risks and potential complications. These complications may include:

Infection: There is a risk of infection anytime an instrument is introduced into the body. However, the risk is relatively low with hysteroscopy. Antibiotics are sometimes prescribed before the procedure to minimize this risk.

Bleeding: Some degree of bleeding is normal after a hysteroscopy, but excessive bleeding can occur in rare cases. Women who are prone to bleeding disorders may be at a higher risk.

Perforation: There is a small risk of perforating the uterus or damaging other pelvic organs during the procedure. Perforation may require additional surgery to repair.

Fluid overload: During hysteroscopy, a liquid or gas may be used to expand the uterus for better visibility. In rare cases, the absorption of excessive fluid can lead to fluid overload, which may cause complications such as electrolyte imbalance or respiratory distress.

Allergic reaction: Some individuals may have an allergic reaction to medications or substances used during the procedure, such as anesthesia or the fluids used to expand the uterus.

Adverse reaction to anesthesia: If general anesthesia or sedation is used, there is a risk of complications related to the anesthesia, such as respiratory problems or allergic reactions.

Persistent pain: Some women may experience persistent pelvic pain or discomfort after the procedure.

Fertility issues: In rare cases, hysteroscopy may cause scarring or other damage to the uterine lining, potentially affecting fertility.

[drasmitadongare]

Choosing the right gynecologist is important for every woman’s health and well-being. Whether seeking routine check-ups, managing a pregnancy, or dealing with complex gynecological issues, having a trusted and experienced specialist can make a significant difference in your healthcare journey.

[drvinayshahmd]

Most common surgeries done by gynecologist surgeon

Gynecology surgery comprises any surgical procedure that involves the organs and structure of the female pelvic region: the ovaries, uterus, fallopian tubes, cervix, vulva, and vagina. There are several reasons why a woman might need to go through gynecology surgery. She might need treatment for a condition such as fibroids (benign tumors), endometriosis, cancer, ovarian cysts, pelvic inflammatory disease, chronic pelvic pain, abnormal bleeding or uterine prolapse. Gynecology surgery can also be used as permanent birth control.

The most common surgeries done by gynecologist surgeon are as follows:

Cervical Cryosurgery

Abnormal cervical cells are at times discovered during a routine Pap smear. Abnormal cells do not always indicate cancer, but your healthcare provider will likely want to do some follow-up tests or procedures. One procedure they might recommend is cervical cryosurgery. This procedure is a highly effective gynecological treatment that freezes a section of the cervix. Cryosurgery destroys these cells to stop them from developing into cancer.

Hysteroscopy

Hysteroscopy is a process that your healthcare provider may use to diagnose or treat uterine issues. This procedure might be used to:

Locate an intrauterine device

Remove adhesions (scar tissue)

Determine the cause of repeated miscarriage

During this procedure, a healthcare professional inserts a hysteroscope, a lighted, thin, telescope-like instrument, into your uterus through the vagina. Then, it sends pictures of your uterus to a screen for further test.

Pelvic Laparoscopy

Laparoscopy is a surgical procedure usually performed under general anesthesia. But it can be performed with other types of anesthesia while you are awake. It is used for:

Gallbladder removal

Tubal ligation (tying the fallopian tubes for permanent birth control)

Treating endometriosis and uterine fibroids

Hernia repair

The typical pelvic laparoscopy involves a small incision in the belly button or lower abdomen. A surgeon then pumps carbon dioxide into your abdomen to help them see your organs easily.

Dilation and Curettage 

It is one of the most common gynecological procedures. During this process, a healthcare provider removes a portion of your uterine lining with a suction device or a sharp curette. The procedure can diagnose uterine conditions, including: 

Uterine cancer 

Endometrial hyperplasia (an abnormally thick uterine lining)

Uterine polyps (overgrowth of tissue in the uterine lining)

In addition, D&Cs are commonly used for miscarriage, abortion procedures, molar pregnancy, and retained placenta.

Common gynecological procedures by gynecologist surgeon include colposcopy, cervical cryosurgery, D&C, LEEP, hysteroscopy, and pelvic laparoscopy. Most of these procedures can help healthcare providers get a better look at the cervix, uterus, and vagina and take samples for a biopsy. Some of them can also treat specific conditions.

Understandably, you might have concerns about any process your healthcare provider or gynecologist recommends. Learning as much as you can is a good idea. In addition, it is essential to ask your doctor any questions you might have. Finally, do not forget to tell them if you may be pregnant, even though they usually do a test to check first.

[meg2md]

Wow, you're off Tumblr for months and the UI gets more fucked up than ever! Nice. How does Tumblr do it? Keep getting worse and worse? And yet I still come back to this website occasionally, because I'm also trash.

Residency makes it hard to keep a blog. I barely have time for household chores and hobbies, let alone ONLINE journaling when I'm also pouring out my heart occasionally on my actual, IRL written journal and trying to maintain friendships.

Anyway. Started R2. It's actually better so far, as much as I felt I was never going to be ready. Don't get me wrong, I still feel woefully inadequate approximately all of the time. But wow, does it feel good to not hold the gyne and OB pager, to not have to fight with the nurses about pitocin on the floor, to do something other than manage labor on OB days. I started on nights, which I thought was going to be a disaster, but actually ended up being fine. I think I got lucky, because usually the R2 gets blown up since they manage antepartum AND gynecology overnight, but the ED and antepartum nurses were relatively benign to me.

And just... the FREEDOM of not having to write q2h strip and mag notes, to not have to pay hawk-like attention to the strips... and the nurses and I get along better than ever now that

A) they have new intern prey to feast upon, and

B) I'm not riding everyone's ass about the strips

Literally, my LEAST FAVORITE PART OF MY JOB is being a labor intern because you're expected to make sure the pitocin keeps going up, up, up but the nurses don't always want to with a category 2 strip, but like, category 2 doesn't mean it's not reassuring, and also you can't have a baby without contractions, but there's always a "policy" for why we can't do XYZ.... and it's like... why am I even here then, just run the labor floor without me if everything is 100% policy-driven, lol. Category 2 isn't BAD guys!!! It's not always bad. And I know the strips aren't always amazing but dude.... we either pit enough we can get a baby out vaginally or they might as well get cut here and now instead of spinning our wheels with inadequate pitocin dosing.

Anyway... rant over hahaha. Ooooh I hated labor as an intern. I loved it in the beginning, but I QUICKLY, QUICKLY came to dread it for the above reasons. And now, as an R2 on OB days, my primary job will be c-sections! Which is incredible because right now I feel like I'm so bad at them. I've done a few over 20 since I started residency. Other programs have you do more as an intern, but I did end up with >200 vaginal deliveries, so I really can't complain. And like I said, my OB days blocks will be me doing 2-5 sections per day... so I'll get real good real fast. I just don't do it for awhile (nights > family planning > oncology > OB days) so I feel nervous when I'm assigned sections on nights and call, but I'll get there eventually. TRUST THE PROCESS, they say. I mean, I guess I thought I'd never figure out how to insert a hysteroscope into a uterus and chomp off an intracavitary leiomyoma, and I figured that out by the end of R1, so there's got to be something to it.

Things I still don't feel good about that I should have gotten better at by the end of R1: LACERATION REPAIRS. But whatever. I'm sure it will improve as my surgical skills improve.

Now I'm starting to stress because in the middle of having more responsibility, figuring out C-sections and basic laparoscopy, etc, I have to get research started and decide once and for all if I want to do fellowship. I've been waffling between generalist practice and MIGS for ages.

On one hand, I do like obstetrics more than I initially expected, I like that I'll have more freedom to do abortion care, and the thought of MORE training when I'm already almost 32 and have 2.5 years left of residency makes me want to vomit. On the other hand, the MIGS lifestyle is much better than OB lifestyle, I may still be able to do abortions, and I really, REALLY want to have elite surgical training. I'm sure I'll figure it out more on my gynecology and oncology blocks when I do more minimally invasive/generally spend more time in the OR. Not sure how much I like the thought of running a chronic pain and endometriosis clinic. But also... I feel like I went to a decently-tiered medical school and graduated with the assumption I would do fellowship, and to cut my training short and arguably without satisfactory surgical training feels bad. Because at the end of the day, I'm not actually sure how well general OB/GYN residency prepares you for surgery. I'm not sure I trust it yet.

C'est la vie. Back to other things. Studying hormonal contraception in patients with medical co-morbidities before biking back to my house to play MASS EFFECT 3. I'm also a pickle ball fanatic now.

Byeee