Lesley Breech

98 timestamped statements across 2 topics — auto-found in recorded discussions, each timestamp jumps to the exact moment.

Featured statements

▶ Ep 7 · 4:46
If you have a big paratubal cyst, that increase the risk of torsion. So if someone has a paratubal or paraovarian cyst, yes, I agree with you. I want you to remove that, baby. Don't aspirate that baby because we're coming back later to get that when the next torsion happens.
quote · Ovarian Torsion
▶ Ep 1 · 6:20
After a torsion, it's really not the time that we want to do the oophoropexy. It's really an interval procedure when you have fabulous looking ovaries because the ovary has healed well.
quote · Adnexal Torsion
▶ Ep 3 · 0:46
Dr. Breach teaches us that that big cystic thing is a paratubular or a wolffian duct remnant. Those are the things that create risk for twisting and they typically happen at puberty.
quote · Adnexal Torsion
▶ Ep 8 · 9:50
When intervening acutely during the time of a torsion, we can damage the ovary, and our goal is for follicular survival. So that really helps preserve future fertility.
quote · Ovarian Torsion

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Lesley's statements about Adnexal Torsion 54 statements

Open the Adnexal Torsion collection →

GYN #2 Oophoropexy in Adnexal Torsion with Dr. Lesley Breech

▶ Ep 1 · 0:43
quote In this case, and in many cases, the finding is actually a big, edematous fallopian tube. Many times, it's not actually not even an actual cyst that is sitting there. ↗
▶ Ep 1 · 0:43
clinical In many cases of adnexal torsion, the finding is a big edematous fallopian tube rather than an actual cyst. ↗
▶ Ep 1 · 1:00
clinical In a five year old, you wouldn't really find a paraovarian or wolfian duct cyst, as those present really after puberty. ↗
▶ Ep 1 · 1:25
clinical In little girls after untwisting, there is a large edematous ovary and it's really hard to find any place to put it, and it could retorse right away. ↗
▶ Ep 1 · 1:45
clinical In a teenager, there is space, and you could leave a large edematous ovary in the pelvis to let the edema come down. ↗
▶ Ep 1 · 2:10
clinical There is no definitive time frame for ovarian torsion, unlike testes that only have a very short lifespan. ↗
▶ Ep 1 · 2:25
clinical The ovary is more resilient than testes and it rebounds. ↗
▶ Ep 1 · 2:25
quote The ovary is more resilient and it rebounds, so we would recommend preserving any potential fertility in the future. ↗
▶ Ep 1 · 2:45
guideline Oophoropexy is not recommended at the time of detorsion in prepubertal girls. ↗
▶ Ep 1 · 3:00
epidemiological Recurrent torsion constitutes about 10 to 15% of all cases of torsion in the pediatric population. ↗
▶ Ep 1 · 3:15
clinical Torsion is more common on the right side because there's no sigmoid colon to protect it from twisting. ↗
▶ Ep 1 · 3:30
guideline The American College of Obstetricians and Gynecologists does not recommend doing oophoropexy for every patient who has a torsion in teenagers. ↗
▶ Ep 1 · 3:50
clinical Good communication between the fallopian tube and ovary is important so that when ovulation is happening, the tube gets the eggs and brings it down to meet the sperm. ↗
▶ Ep 1 · 3:50
quote We want the fallopian tube and the ovary to be in great communication. So when ovulation is happening, the tube is right there. It gets the eggs and brings it right down the fallopian tube to meet the sperm. ↗
▶ Ep 1 · 4:15
clinical If doing an oophoropexy and placing the ovary in a safe place, you might unfortunately interrupt good communication with the fallopian tube and ovary. ↗
▶ Ep 1 · 4:35
clinical Providers could iatrogenically introduce some degree of impairment in fertility if not oophoropexying in the right site. ↗
▶ Ep 1 · 5:00
epidemiological About 30% of oophoropexies end up failing. ↗
▶ Ep 1 · 5:10
clinical Utero-ovarian ligament shortening is one of the oophoropexy approaches that fails more commonly than other approaches. ↗
▶ Ep 1 · 6:00
clinical At the time of actual torsion, the ovaries can look horrible, very edematous and hemorrhagic in nature. ↗
▶ Ep 1 · 6:20
quote After a torsion, it's really not the time that we want to do the oophoropexy. It's really an interval procedure when you have fabulous looking ovaries because the ovary has healed well. ↗
▶ Ep 1 · 6:20
clinical After a torsion, it's not the time to do the oophoropexy; it's an interval procedure when you have fabulous looking ovaries because the ovary has healed well. ↗
▶ Ep 1 · 6:45
clinical Gynecologists use a three-point fixation for stabilization: the uterosacral ligament, the pelvic sidewall, and shortening the uteroovarian ligament. ↗
▶ Ep 1 · 8:00
clinical In prepubertal girls, it can take much longer for edema to regress and come down. ↗
▶ Ep 1 · 8:15
clinical We often don't re-image for as long as about two to three months so that edema is completely resolved. ↗
▶ Ep 1 · 8:40
guideline Follow-up ultrasound should always be done after detorsion. ↗
▶ Ep 1 · 8:50
epidemiological About 46% of patients won't have any real persistent mass or lesion in the ovary after detorsion. ↗
▶ Ep 1 · 9:05
clinical Some patients may have a longer utero ovarian ligament or longer infundibulopelvic ligament as anatomic differences that predispose them to torsion. ↗
▶ Ep 1 · 9:25
clinical Literature suggests that if you have a very hemorrhagic edematous ovary, you can damage the ovary more by doing cystectomy then, than waiting to do it later. ↗
▶ Ep 1 · 9:50
clinical When intervening acutely during the time of a torsion, we can damage the ovary, and the goal is for follicular survival to preserve future fertility. ↗
▶ Ep 1 · 9:50
quote When intervening acutely during the time of a torsion, we can damage the ovary, and our goal is for follicular survival. So that really helps preserve future fertility. ↗

GYN #3 Management of an Adnexal Torsion with a Healthy Appearing Ovary with Dr. Lesley Breech

▶ Ep 2 · 1:12
quote In general, when we talk about the ovary, we don't really ever want to take an ovary out. ↗
▶ Ep 2 · 1:12
clinical When managing ovarian torsion, the goal is to never take an ovary out ↗
▶ Ep 2 · 1:12
clinical A severely damaged fallopian tube can develop into a hydrosalpinx, which negatively impacts IVF success and leads to ectopic pregnancies ↗
▶ Ep 2 · 1:35
quote This can actually negatively impact your IVF success leading to ectopic pregnancies. ↗
▶ Ep 2 · 1:43
quote As a pediatric gynecologist, I really don't want to be recommending that we just go into the OR when we're really flamboyant about going ahead and taking out a fallopian tube. ↗
▶ Ep 2 · 1:50
clinical After detorsion, if a fallopian tube looks severely damaged, it should be photographed and documented to inform long-term care providers about its condition ↗
▶ Ep 2 · 2:30
clinical When a fallopian tube has had significant trauma without improvement in health, removal of the tube should be considered to decrease further reproductive risk associated with a poorly functional tube ↗
▶ Ep 2 · 3:20
clinical In gynecology, recurrent torsion is defined as occurring more than once ↗
▶ Ep 2 · 3:30
quote Gynecologist call it recurrent as anytime more than once. ↗
▶ Ep 2 · 4:49
quote And actually that's due to the inflammation process that's happening. ↗
▶ Ep 2 · 4:49
clinical Elevated CA-125 in torsion is due to the inflammation process, not tumor presence ↗
▶ Ep 2 · 4:49
clinical For suspected torsion, the patient should be taken to the OR, the structure detorsed, and management decisions made based on intraoperative findings, with follow-up later ↗

GYN #4 Management of Tubal Torsion: When to Consider Salpingectomy with Dr. Lesley Breech

▶ Ep 3 · 0:46
quote Don't forget to complete the resection because it will return. ↗
▶ Ep 3 · 0:46
clinical When doing this kind of resection, it is really important to trace the path of the fallopian tube. ↗
▶ Ep 3 · 0:46
quote Dr. Breach teaches us that that big cystic thing is a paratubular or a wolffian duct remnant. Those are the things that create risk for twisting and they typically happen at puberty. ↗
▶ Ep 3 · 0:46
clinical In managing adnexal torsion with a Wolffian duct remnant, the key steps are: accurately diagnose, promptly untwist the adnexa, carefully resect the cyst wall, and ensure the fallopian tube's integrity. ↗
▶ Ep 3 · 0:46
clinical Incomplete resection of the cyst will result in recurrence. ↗
▶ Ep 3 · 0:46
clinical It is not a problem to get into the mesosalpinx during resection, but protection of the fallopian tube path is critical. ↗
▶ Ep 3 · 0:46
quote It's really important to ensure that we resect the entire cyst wall. ↗
▶ Ep 3 · 0:46
quote When doing this kind of resection, it is really important to trace the path of the fallopian tube. ↗
▶ Ep 3 · 0:46
clinical The cystic structure in this case is a paratubular or Wolffian duct remnant. ↗
▶ Ep 3 · 0:46
clinical Paratubular or Wolffian duct remnant cysts create risk for twisting and typically happen at puberty. ↗
▶ Ep 3 · 0:46
clinical It is really important to ensure complete resection of the entire cyst wall. ↗
▶ Ep 3 · 0:46
clinical The fallopian tube is typically seen stretched across the cyst. ↗
Lesley's statements about Ovarian Torsion 44 statements

Open the Ovarian Torsion collection →

Update Course Rewind: Ovarian Torsion Management 2023

▶ Ep 7 · 1:21
clinical Apparent cystic areas on ultrasound in ovarian torsion cases are often actually edema of the fallopian tube rather than true cysts. ↗
▶ Ep 7 · 2:17
quote We should be never doing an oophorectomy. And there isn't good data that would show us the timeline and the appearance that would say the ovary is not going to live. ↗
▶ Ep 7 · 2:17
clinical The standard approach is to always detorse the ovary and leave it in place. ↗
▶ Ep 7 · 2:17
clinical There is no good data showing a timeline or appearance that would indicate an ovary will not survive after torsion. ↗
▶ Ep 7 · 2:59
clinical For a black, edematous fallopian tube in a prepubertal girl, there is plenty of time to figure out management. ↗
▶ Ep 7 · 2:59
clinical Scarring of the fallopian tube is a concern for future fertility and increases risk for ectopic pregnancies. ↗
▶ Ep 7 · 2:59
clinical In adolescent patients with edematous fallopian tubes, future tubal function is a concern because the tube must be patent and have open fimbria to function properly. ↗
▶ Ep 7 · 4:46
quote If you have a big paratubal cyst, that increase the risk of torsion. So if someone has a paratubal or paraovarian cyst, yes, I agree with you. I want you to remove that, baby. Don't aspirate that baby because we're coming back later to get that when the next torsion happens. ↗
▶ Ep 7 · 4:46
clinical With significant edema, it is difficult to determine intraoperatively if there is underlying pathology in the ovary that needs to be removed. ↗
▶ Ep 7 · 4:46
clinical Most gynecologists untwist the ovary, leave it in place, and obtain follow-up imaging to identify any underlying ovarian pathology that might have caused the torsion. ↗
▶ Ep 7 · 4:46
clinical The highest risk of torsion in an edematous ovary is in prepubertal girls. ↗
▶ Ep 7 · 4:46
clinical Paratubal or paraovarian cysts increase the risk of torsion and should be removed rather than aspirated to prevent recurrence. ↗
▶ Ep 7 · 5:32
clinical In pubertal females, the posterior cul-de-sac has sufficient room to accommodate a 4-5 centimeter ovary with a cyst, which occurs monthly with ovulation. ↗
▶ Ep 7 · 6:28
clinical There is a risk of re-torsion in an edematous ovary, but time should be given for the edema to resolve while attempting to preserve the ovary. ↗

GYN #2 Oophoropexy in Adnexal Torsion with Dr. Lesley Breech

▶ Ep 8 · 0:43
quote In this case, and in many cases, the finding is actually a big, edematous fallopian tube. Many times, it's not actually not even an actual cyst that is sitting there. ↗
▶ Ep 8 · 0:43
clinical In many cases of adnexal torsion, the finding is a big edematous fallopian tube rather than an actual cyst. ↗
▶ Ep 8 · 1:00
clinical In a five year old, you wouldn't really find a paraovarian or wolfian duct cyst, as those present really after puberty. ↗
▶ Ep 8 · 1:25
clinical In little girls after untwisting, there is a large edematous ovary and it's really hard to find any place to put it, and it could retorse right away. ↗
▶ Ep 8 · 1:45
clinical In a teenager, there is space, and you could leave a large edematous ovary in the pelvis to let the edema come down. ↗
▶ Ep 8 · 2:10
clinical There is no definitive time frame for ovarian torsion, unlike testes that only have a very short lifespan. ↗
▶ Ep 8 · 2:25
clinical The ovary is more resilient than testes and it rebounds. ↗
▶ Ep 8 · 2:25
quote The ovary is more resilient and it rebounds, so we would recommend preserving any potential fertility in the future. ↗
▶ Ep 8 · 2:45
guideline Oophoropexy is not recommended at the time of detorsion in prepubertal girls. ↗
▶ Ep 8 · 3:00
epidemiological Recurrent torsion constitutes about 10 to 15% of all cases of torsion in the pediatric population. ↗
▶ Ep 8 · 3:15
clinical Torsion is more common on the right side because there's no sigmoid colon to protect it from twisting. ↗
▶ Ep 8 · 3:30
guideline The American College of Obstetricians and Gynecologists does not recommend doing oophoropexy for every patient who has a torsion in teenagers. ↗
▶ Ep 8 · 3:50
clinical Good communication between the fallopian tube and ovary is important so that when ovulation is happening, the tube gets the eggs and brings it down to meet the sperm. ↗
▶ Ep 8 · 3:50
quote We want the fallopian tube and the ovary to be in great communication. So when ovulation is happening, the tube is right there. It gets the eggs and brings it right down the fallopian tube to meet the sperm. ↗
▶ Ep 8 · 4:15
clinical If doing an oophoropexy and placing the ovary in a safe place, you might unfortunately interrupt good communication with the fallopian tube and ovary. ↗
▶ Ep 8 · 4:35
clinical Providers could iatrogenically introduce some degree of impairment in fertility if not oophoropexying in the right site. ↗
▶ Ep 8 · 5:00
epidemiological About 30% of oophoropexies end up failing. ↗
▶ Ep 8 · 5:10
clinical Utero-ovarian ligament shortening is one of the oophoropexy approaches that fails more commonly than other approaches. ↗
▶ Ep 8 · 6:00
clinical At the time of actual torsion, the ovaries can look horrible, very edematous and hemorrhagic in nature. ↗
▶ Ep 8 · 6:20
clinical After a torsion, it's not the time to do the oophoropexy; it's an interval procedure when you have fabulous looking ovaries because the ovary has healed well. ↗
▶ Ep 8 · 6:20
quote After a torsion, it's really not the time that we want to do the oophoropexy. It's really an interval procedure when you have fabulous looking ovaries because the ovary has healed well. ↗
▶ Ep 8 · 6:45
clinical Gynecologists use a three-point fixation for stabilization: the uterosacral ligament, the pelvic sidewall, and shortening the uteroovarian ligament. ↗
▶ Ep 8 · 8:00
clinical In prepubertal girls, it can take much longer for edema to regress and come down. ↗
▶ Ep 8 · 8:15
clinical We often don't re-image for as long as about two to three months so that edema is completely resolved. ↗
▶ Ep 8 · 8:40
guideline Follow-up ultrasound should always be done after detorsion. ↗
▶ Ep 8 · 8:50
epidemiological About 46% of patients won't have any real persistent mass or lesion in the ovary after detorsion. ↗
▶ Ep 8 · 9:05
clinical Some patients may have a longer utero ovarian ligament or longer infundibulopelvic ligament as anatomic differences that predispose them to torsion. ↗
▶ Ep 8 · 9:25
clinical Literature suggests that if you have a very hemorrhagic edematous ovary, you can damage the ovary more by doing cystectomy then, than waiting to do it later. ↗
▶ Ep 8 · 9:50
clinical When intervening acutely during the time of a torsion, we can damage the ovary, and the goal is for follicular survival to preserve future fertility. ↗
▶ Ep 8 · 9:50
quote When intervening acutely during the time of a torsion, we can damage the ovary, and our goal is for follicular survival. So that really helps preserve future fertility. ↗