Case Study: Robotic Hysterectomy

The patient is a 48-year-old female, who had a D&C and removal of a large polyp at Allegheny Hospital 01/2017. The patient states that she has had two weeks of heavy bleeding out of four weeks since the D&C. She was told they removed a large polyp but could not get all of the polyp out. No ablation was performed at that time. Doctor's notes from that physician were obtained which showed an ultrasound with a 2.4 cm fibroid, normal ovaries, and benign endometrial biopsy. Surgery notes have not been obtained or pathology from the polyp. The patient has recently seen her cardiologist. She has been changed on her cardiac medications. Her heart cardiac output is 67%. She has lost 7 pounds which she claims has been mainly from fluid in her lower …show more content…
The patient feels healthy except she is extremely tired of passing large clots for two weeks out of every month. She presently has nearly stopped bleeding. There was a 15 minute discussion on alternatives of retrying the hysteroscopy D&C and performing an endometrial ablation. The option of going to University of Virginia for referral for possible robotic hysterectomy. The patient does not want an IUD at this time. Her exam at the last visit the os of the cervix could not be sounded and was extremely painful. The patient was discussed a trial of Megace. The patient has never had a blood clot in her lower extremities but is high-risk for that and was warned of the signs of a blood clot secondary to the medication. The patient was given 40 of Megace a day for 14 days each month and to be