Stuart Winkler

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394 appearances 1 recordings 1 series first heard Jul 2026 last heard 23 Jul

Stuart Winkler’s voice in public audio — every appearance, attributed to the second.

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Thinking About Ob/Gyn · Episode 12.2 Cuff Dehiscence and Classic Papers · 23 Jul 2026 podcast

There really isn't much evidence on this, but I would typically do a diagnostic laparoscopy on a patient with exposed bowel.

I think that just makes sense to do that.

And the reason is you want to look at the bowel when it's back in situ to make sure that it's well vascularized.

So even bowel that looks dusky coming out of the vagina can actually pink up pretty well when you put it back into the abdomen.

And so uh the actual uh

Amount of time that I've done a bowel section for these is pretty pretty uncommon, to be honest.

So I've also used I talked about this with the previous tips, but I've used IV IG in this situation before as or sorry, IV I C G.

I was about to say Yeah, I do not I do not give IG IV IG.

Yeah, I do not

But the ICG that we use for sentinel lymph node mapping, you can give that IV.

Usually give about 2.5 cc's of that.

Or sorry, it's about a sorry, it's 2.5 cc's, sorry, 25 milligrams in 10 cc's of water, and you give one milligram of that.

So it ends up being 2.5 milligrams.

So you can give that IV, and then just you can actually you don't need a robot for this.

There are near infrared scopes that you can use as well.

And sometimes that helps.

You can see the bowel pink up, or actually green.

green up and that's a a kind of an extra helpful thing that I'll do sometimes.

So exposed bowel, like I said, doesn't usually need to be resected, but you want to be thinking ahead and make sure you have somebody available to do that if necessary.

And then I would also do a laparoscope in patients who have signs of infection or might need a washout for any other reason or just an exploration to make sure there's not like a a abscess behind the cuff that maybe was the cause of the cuff dehiscence in the first place.

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