How are you, good afternoon. Today we are going to show you in the MRI a patient who wrote to me in November, from Honduras and who we are going to operate on right now, she is 40 years old and does not have children, obviously the main reason for her consultation was abnormal uterine bleeding, that is, bleeding during the menstrual period but I also had intermenstrual bleeding called spotting and also a little pain and constipation.

So, let’s observe right now, look, here is the umbilical scar, when we start to move forward, we realize… The little green dot tells us where the umbilical scar is, see how you can see the entire tumor, we colored this It’s not really an MRI, so you could see the part down here as a little bit of red appears, so this patient sends me the image, we are moving it here, see what the tumor looks like and what we are going to show you right now is In the sagittal section, that is, on the left side of the hip, we are getting into it, here we can see perfectly well when the hip begins, the kidney is also observed, but see the most important thing: Here is the tumor, this white part that we see here , which we observe, is the bladder and then we also see this green line that we said, look, I’m going to raise it a little, but the strip is on the edge or at the limit of the navel.

I always tell my patients when they tell me, the limit for my surgery to perform pfannenstiel surgery, that is, on the bikini line or a stocking, is the navel. For any tumor that is below the umbilical scar, we generally make a pfannenstiel aesthetic incision, but for any tumor that is above, we mainly make a medial incision. See, I’m going to make it very big, this looks great because the bladder is completely well differentiated, the tumor and see this line as a groove, a kind of large “C” this is the uterine cavity, which is really displacing the uterus, the fibroid and the anterior surface is free, so this patient is very interesting, we will surely have to enter the cavity but we will see it in the video later.

Good morning, today we are going to do a little patient who comes from Honduras, Tegucigalpa, again because she also saw us on YouTube, because of the surgeries that we have uploaded, she is a 44-year-old patient who has no children and has an intramural tumor very large cigar, more or less 15 or 16 centimeters, he sent me the MRI, then later I will show you that he looks perfectly fine but then everyone told him that they were going to remove his uterus, fortunately he does not have anemia although one of his symptoms The main ones were abnormal uterine bleeding during menstrual cycles, so right now we are infiltrating vasopressin and we are going to start making a mid-body incision and then resecting the tumor. We will surely have to do morcellation because it is quite large and we made a pfannenstiel incision. We are going to start morcellating because the incision was really too small, the tumor is very large, we already managed to differentiate the capsule but we believe that it was inside the endometrial cavity, although now that we finish we will assess how the restructured uterus looks. The important thing here is obviously to remove the tumor and then see how we look for the reproductive future.

Ready, we’re done, look at her very beautiful ovary on the right side, the right tube, round ligament, look at the transfictive stitches that we put in, we practically put in about 12 transfictive stitches because the musculature was very large, see how beautiful the left ovary is , the tube, but the uterus was perfectly fine, we saved it, it is not bleeding, the surgery lasted an hour and 40 minutes, it was very difficult, the tumor is more or less the size of a melon.

As you could see right now in surgery, I always tell patients, the MRI matters a lot to me and it helps me give them a reproductive prognosis, to give them a prognosis for surgical time and bleeding. This patient bled us 300 milliliters, she had told her two and a half hours, it took us an hour and fifty. So, the most important thing is that you are aware and well oriented about the type of surgery you are going to have, the surgical time, the risk of bleeding and the risk of removing the uterus or not.

I always tell them: A second opinion or a third opinion is very important before deciding to remove a uterus, we are at your disposal on the Creafam page, we also have virtual consultations by Zoom, by Skype or Whats, so go to our page Call us and we can consult with you.

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