Hello! Good morning, we are here with you again for the same topic of uterine fibroids, we have had an excellent response from all the patients both in Puebla but also in the state of Tamaulipas, the state of Guerrero, the state of Oaxaca, and Veracruz .

They have written to us a lot, we have had quite a few consultations via Zoom and right now what I want to show you and tell you is the different types of fibroids and also the studies that we have to do beforehand, well to have a little more security at the time of surgery, remember #KnowledgeIsSuccess

The first patient that you are going to see in the video is a very interesting fibroid because this fibroid, we have in the uterus the anterior lip and the posterior lip, which basically the cervix is as if they were our lips, so the posterior lip that faces the bottom of Douglas, that is, towards the roof of the vagina, that is where this fibroid began to grow, which could be said to be retro cervical or intra cervical, but it grew in the abdomen towards an area called the retroperitoneum. What does that mean? We have the abdominal cavity, there is the anterior wall and there is the posterior peritoneum or the rectroperitoneum, where it is covered, so to speak, with a sheet, which are all the great vessels of the mediastinum and also, for example, the spinal column, so this fibroid was not In the abdomen, it was not where the intestines are, it was not where the uterus was, where the ovaries are, but there was something that we call intra ligamentary, that is, between the sheet of the cervix and the sheet that faces the abdomen.

So, this little patient wrote to us from Tamaulipas. Her main problem is first that she has not been able to get pregnant and secondly she is 37 years old, but her symptoms were that she already had urinary urgency, the fibroid was so large that it compressed a little, or it pushed the uterus forward and therefore put pressure on the bladder and then the The patient every time or constantly had the sensation of going to the bathroom and made a mistake or was often treated as if they were urinary infections. When I reviewed it via Zoom, he sent me the ultrasounds and something very curious, from the abdominal ultrasound it seemed that this fibroid was inside the uterine muscle, however, the day he came for the surgery we did not ask for an MRI, which is an important part there. The MRI or CT scan makes small specific cuts of the uterus and pelvis and that would have guided us even better in the anatomy where the fibroid is located. We entered the surgery and when we opened it we found that we couldn’t find where the fibroid was because it was covered by that little sheet that I told you at the bottom of Douglas, so we are going to show you the video, it was very interesting, difficult to access, very laborious because It is in the great vessels to remember that the uterus, on the posterior surface where it descends towards the vagina, is the cervix, but there are several vessels there, which are the uterine vessels that supply the uterus obviously, the cervical uterus that supply the cervix and the uterus, and the cervical vagina. that is, those that supply the vagina and the cervix, so it is an area very congested with blood vessels. The important thing here was that once we entered, how it was resolved. We had to go vaginally to use forceps to puncture the fibroid and throw it into the cavity and then make the incision inside the abdominal cavity, so you will see that it is a very beautiful, very laborious surgery that fortunately had almost no bleeding and This patient did not have anemia.

Good afternoon, we are going to start another fibroid surgery, a 37-year-old 11-month-old patient who wrote to us just a month or so ago from Reynosa, Tamaulipas. She really noticed the fibroid because she was compressing her bladder and was having problems with urinary urgency plus symptoms as if they were urinary infections. When she went to the doctor, they performed an ultrasound and discovered that she had a fibroid with large elements on the anterior surface and then they told her that they were going to remove her uterus.

You make your consultation with us, we review the images, we send you an MRI, it is a single fibroid on the anterior surface of more or less 7 centimeters and you have a subserous fibroid that is not very important, but we are going to start the surgery and we are going to go describing how it is. Look, you can’t see almost anything, because this fibroid… I’m going to remove the uterus a little bit, the uterus is here and the fibroid started to grow just like the surgery we did on the two kilo patient. It began to grow in the cervix, but it was not aborted but rather it began to dilate or displace the uterus above. This is the most difficult surgery we have ever done… We always say that there is a difficult surgery, but the thing is that we have more and more cases. complicated.

This little patient has it in Douglas’ sac and in her cervix, on her posterior lip. The problem is the anatomy is very difficult because it is already very close to the sigmoid rectum for us to understand, but the most important and most problematic thing, that entire area is full of cervical, vaginal, uterine vaginal blood vessels, so it is an area that is too bloody. and with a high risk of bleeding. Look closely, we are more or less finishing this is the uterine fundus, the ovaries are here on the back of the uterus, but look at the impressive hole that it has at the bottom, we are not finished yet but anatomically I will explain it later because this is well Interesting, this one of mine is very difficult for me, the truth is that we are almost finished, but we have to make sure that there is no significant bleeding because it is in the mere area of all the cervical and uterine vaginal vessels.

Ready, we’re almost done. Finally! A very laborious and difficult surgery, but see this is the pedicle, nothing more than the pedicle is attached to the posterior lip of the cervix, so now that we finish resecting it I want to show you how it looks because the anatomy is really too complex and complicated, but fortunately the The patient has only bled 150-200 milliliters and we are now going to finish the surgery.

Interestingly, when we did the vaginal mirror, the fibroid was clearly seen protruding towards the vagina on the roof, at the uterine fundus, but we could not operate on it from below because, as I mentioned, that fibroid was in the cervix and if I entered from below and I want to resect the large uterine and cervical vessels rather we can control them abdominally, it was very dangerous to do it from below because we were not going to have control of whether that patient was bleeding, since we would have to open from above to try to ligate and avoid the bleeding, so that’s why we decided to enter from above, although the fibroid also protruded a little from below, but it was because of its large size.

And the other patient that we just operated on yesterday is a patient from Coatzacoalcos Veracruz, who is 45 years old, so I wanted to show you the two cases because a 37-year-old patient without children and her main query or mortification or concern was fertility, preserving it And also, obviously that fibroid was already causing him problems. 3 or 4 doctors in Tamaulipas had already told her that they were going to remove her uterus and that’s why when she saw the videos she said: “I’m going to go to a consultation”, she came and had the operation and the second one that I am mentioning to you is a patient who She already has two children, she even had two cesarean sections, a mid-incision in the abdomen, but she has a large, intramural fibroid that is a little degenerated, that is, it is not solid, it is rather cystic, but her main problem is anemia. She had intermittent bleeding and uterine hemorrhages in her menstrual cycles that were leading to moderate anemia with fatigue, dizziness, and palpitations. She could no longer do her normal activities because she became agitated and tired and that’s why she came to us.

In it, if we did a tomography that you are even going to see, we are going to show it there in the surgery, because it is very important to know that we already had a diagnosis of where that uterus was anatomically: Intramural, anterior face, uterine fundus but also We also assumed that the fibroid was going to be degenerated.

Good afternoon, here we are again with a myomatosis surgery, apparently it is a single intramural fibroid that invades the anterior cavity. The patient is 45 years old, she is from Veracruz, Coatzacoalcos. But it came mainly because of the problem of anemia, so this patient has a hemoglobin of 8.8 even though she is receiving hematids, so the intention of the surgery is obviously to eliminate the bleeding problems she has and we are making a mid-incision because she already has 2 previous cesarean sections, she doesn’t want to remove the uterus, so we are going to try to do a simple myomectomy surgery and preserve the uterus.

Very good, she look she wanted to show them. Here we have the Babcock clamp, see how good the muscle tissue looks, this is the musculature, this is the visceral peritoneum but the fibroid is all degenerated, see how the degeneration is like hyaline cystic, it is watery, in fact it is falling apart because he is patient, or it is a fibroid where they gave him some medication but it is too, too degenerated. Let’s take it out, the advantage of this is that it is too easy to take out through a relatively small incision in the uterus. We must remember that she no longer has a reproductive desire, so that gives us a certain advantage of not worrying about the incision we make in the uterine muscles.

We have already finished removing the fibroid, I wanted to show it so you can see: This is a degenerated fibroid, you see it does not have a capsule at all and obviously its consistency is soft, sebaceous cystic, somewhat irregular and ugly, so, you have to see the muscles, it may be You see the muscles, but inside there are semi-irregular lesions where there is no capsule, but right now we are going to give some coping points so that the bleeding stops. Well, here we are, see, this is another intramural myoma, but this one is on the posterior surface.

Here is the ligament, well no, this is the tubal, the uterine tube, so it is a very vascularized area but it is a smaller fibroid. See this, we already infiltrated it, we are going to make a small digital digit to remove it and grab the pedicle at its base so that nothing bleeds from us. Remember that in that area you always have to be very careful about bleeding and do good hemostasis. It is just the last fibroid, see this is a subserous fibroid, just like what we have always mentioned, the problem with subserosal fibroids is their great vascularity. It has a pedicle that is more or less thick, about a centimeter in diameter, that is where we are going to infiltrate and we are going to remove it, we are done.

So, the most important thing is to make a consultation with us by zoom, remember that the vast majority of fibroids with large elements are easier as long as it is a single fibroid, because many times the patient is scared or they mention that it must be removed. the uterus because surgery is a bit difficult or the uterus is very difficult to salvage due to the size of the fibroid. However, I always remind you that the single fibroid, even if it is large, is sometimes much easier to operate on. You have to be more careful about bleeding, but it is resolved much easier and the uterus looks much better anatomically after surgery.

When we have multiple fibroids we have already seen it in several videos, these types of surgeries are more laborious, they also tend to have a little more bleeding and obviously the recovery of the uterus muscles takes a little longer, however, just like the single fibroid, when we have multiple fibroids the important thing is to do a good physical examination, a good diagnosis and with imaging, which in this case was resonance or tomography, can help us to be even more certain about the surgical time and what we will need during the process, so remember to call us.

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