We are going to start with a surgery that we did on a patient who came from California, this patient only arrived on Tuesday to have the surgery on Wednesday, today she was discharged but she is leaving on Sunday, she will return to California again . It is important to know that for foreign patients, the maximum number of days they can stay is between 5 or 7 days, so call us and we can take care of your fibroid problem.

Ok, let’s see, we are going to explain a little bit why we are going to start the surgery. Here we already have the separator, it is a large fibroid but obviously anatomically the uterus is modified, this is the tube, here is the round ligament that comes over here on the right side and there in the background is the right ovary, see what It’s pretty. She is still a very young patient, 35 years old. Left ovary slightly attached to the round ligament and the tube, so the fibroid is on the posterior surface, but it practically covers the entire uterus. She is 35 years old, she already has two children, she contacted me through YouTube, she lives in California and then in Tijuana three doctors had mentioned to her that they had to remove her uterus, we checked her over the internet obviously and made the consultation over Skype. Afterwards I requested the tomography and MRI and she could see the tumor, today, she arrived yesterday, today she is already scheduled and now we are going to see the development of the surgery. We put the vasopressin very delicately so that there are no hemodynamic changes there and the doctor tells us how we can proceed, the anesthesiologist doctor.

– But if they go very far back – Well, their main symptoms were abdominal growth for more or less 6 months to date, in addition to the pain a little during menstruation and that they had moderate bleeding, in fact it brings a mild anemia, now We previously gave him a Renegy, which is iron carboxymaltose and that helps us bring a little iron and transport oxygenation to the tissues, but the tissue is already turning white, so now we are going to infiltrate another 30 ml of vasopressin and We will start the incision. Generally, in almost all fibroids, what we do is do digital-digital finding the plane and then with the finger we dissect when it lends itself, as we are seeing here, there is a little bit of connective fibrous tissue, so what we do is we peel it off. the capsule to be able to remove the vessels and not encounter so much bleeding, the idea is that this patient does not bleed. The vast majority of giant or large fibroids, which often cause us to despair and then begin to bleed, it is true that bleeding can be too profuse and important, but here the idea is to take it calmly, not to do a dissection Although it is bloody, you have to do it slowly.

We are going to morcellate the fibroid, normally the morcellation can be in small pieces, or this one that is being rendered we will try to cut it about in half. Why in half? To be able to see its pedicle and its base and then tie it.

Maybe this surgery or this fibroid would have been perfect to have been done laparoscopically and with morcellation, however, morcellation can also have its risks of bleeding and mainly that a surgery performed laparoscopically with a morcellator is more expensive, so many patients prioritize Having a lower cost, at the end of the day from a reproductive point of view, if we do a careful and clean surgery, it will have the same reproductive prognosis as laparoscopically.

Sometimes we are asked about fibroid embolization. It is very important that embolization is recommended for very specific cases, I always tell them very similar to medications: Embolization, patients in the final stage of reproductive life with perhaps a fibroid or two and who are not older than 5 or 6 centimeters, so that there is not so much bleeding, if it could help… But if it is not in the final stage of reproduction, then the patient will continue to increase her tumor and especially if it was already a fibroid of origin greater than 7 centimeters or 8, it has very few indications. It is too expensive, embolization has a cost very similar to a laparoscopy precisely because it is a non-invasive process, much more sophisticated, complex and then the results depend on the patient and the fibroid, but they are not as encouraging and that is why it is It has been decreasing today in surgical techniques and especially in the reproductive stage. The ideal time for surgery is generally after bleeding, but many times patients with fibroids have constant bleeding, so it is very difficult to know the time of the cycle, sometimes what we do is put them on contraception, but in foreign patients the truth is Well, it doesn’t influence that much, it’s more in the times that they may come, but yes, ideally it would be when she is not in her menstrual period.

Look closely here is the base, it is a pedicle that is too thick, it is literally attached apart from the musculature of the uterus, but many times the key here is to leave a little capsular tissue because it is attached to the great vessels. The large vessels are connective tissue that cause fibrosis and that is what can complicate bleeding surgery. We better choose to get along, taking out those little glasses, lowering them, lowering them and obviously the need to avoid bleeding. We already finished the surgery but this is all endometriotic tissue. Endometriosis is, we will talk later, it is a very constant and very common inflammatory tissue in reproductive patients and in the fertility stage, but the entire right side of the uterus, that is why we are half removing it… The uterus is large so it is not It comes out, later we are going to show them, but it has a very large hole, there is some bleeding, we have to give some hemostatic stitches and deal very well with that hole that was left in the posterior face of the uterus.

But the most important thing is that they know that not all surgeries or not all large fibroids are synonymous with removing the uterus, nor are all patients who have hemorrhages because they have bleeding. Because? Because what we did for this patient was we gave her a Renegy, one day, that is, the day in the morning and in the postoperative period we gave her blood because the control hemoglobin came out at 8.3, she started with 10.5, the bleeding was more or less 500 milliliters And since he returned to California on Sunday, the decision regarding blood, although it did not have a medical criterion because he was stable, had no hemodynamic changes, the pressure was fine, was so that during the trip he would not have any discomfort or any complications. . I want to tell you that all the patients who have not written from abroad, we have the patient from Peru that we already operated on, this patient from California, they have written to us a lot from the USA and some from Canada and some from Colombia.

It is very important to go with someone who can give you a more conservative prognosis, especially from a reproductive point of view. However, the most important thing is that with us you can do a virtual consultation and then if it is within your means you can come and scheduling a surgery without any difficulty because we often take care of planning the stay either in hotel accommodation or in AirBnB and then they organize their trip, but the most important thing is that at Creafam we are increasingly growing in virtual consultations, In the consultations that are not just Mexican, but from other countries and that we can guide them based on what they need for the trip, many times they ask us if it is necessary or if they are asking for the test, I think yes at the level Internationally, all flights require a PCR test for COVID to be able to travel, and that same test can be useful, for example, for the one in Peru, that same test was useful for hospitalization, because it is also true that all patients who are hospitalized they are asked for proof.

So remember #KnowledgeIsSuccess We generally try to preserve the uterus for all reproductive issues but also because many times people are afraid of removing the uterus and do not want to remove the uterus and ovaries.

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