4 Doctors, 6 fibroids and 1 surgery via vagina and abdomen
For multiple fibroids, an inexperienced person performs several diagnostic and extraction interventions, each with its time and cost 💰⏳🤦♀️ But it is possible to complete everything in one consultation and one surgery… If you go to the experts.
Doctors Arturo Valdés, Carlos Monsalve, Otto Paredes and Claudia Cortés simultaneously performed surgeries using the abdominal approach and hysteroscopy, reducing time, costs and risks for our patient.
This video explains how the diagnosis was reached and we can observe the surgeries performed the week after the first consultation.
Introduction
Good morning, let’s talk about myomatosis. What would happen if a patient had multiple fibroids?
That is, intramural fibroids, subserous fibroids, fibroids within the submucosal cavity. When they go to a doctor who may not have the expertise on how to approach a patient with multiple fibroids. On many occasions when they go to the doctor they do a vaginal diagnosis with an ultrasound and they are told “We are going to do a diagnostic hysteroscopy”, they insert the hysteroscope, they say “Oh, you do have a fibroid” and that’s it, the case ends because it’s already they made the diagnosis and then they subjected her to a second surgical procedure to now do a surgical hysteroscopy of those fibroids, but later she will have to do a second abdominal surgery or even a third surgery to see if those fibroids that were in the cavity removed completely.
The most important thing is to know that in a single event we can solve the diagnosis and the surgical process and no longer have to do second or third interventions.
We have two surgeries pending, one is from Ecatepec in the State of Mexico, another patient who will come from Los Angeles, California, and a third patient that I am directing the treatment and management of that wrote to us from Honduras and there is another in Ecuador, so remember , this is not exclusive to Puebla. They can make their consultation online, we can first guide them, direct them and do a therapy, be it medication or even first give medicines to raise hemoglobin if the patient is anemic and then do a surgical procedure with us.
About the patient and the diagnosis.
We had another patient, a little under 37 years of age who came recommended by a very good friend of mine, a surgeon, Dr. Rojas, who when doing a laparoscopy for an appendix problem… She had a problem with inflammation of the appendix, it was an acute abdomen, he entered with the laparoscope, he performed the appendix procedure, but observed that the uterus had multiple very large fibroids and also multiple adhesions. The patient comes to the consultation, I do the directed questioning, she reports pain, abundant intermenstrual bleeding for three months to date, we do the ultrasound, we see a suspicious image in the cavity of a polyp or fibroid and, as I mentioned on other occasions, we did a hysteroson .
With a cannula we introduce fluid into that cavity via the vagina, we do the ultrasound and visualize what the well-differentiated myoma looks like and then we finish the diagnosis. Automatically when doing an abdominal ultrasound we see the multiple intramural and subserosal languages that she had and we scheduled the surgery in a week, this patient with the laboratories we saw that she still had no anemia problems, we scheduled her and the procedure was done in a single surgical event via vaginal, abdominal route and we ended or resolved the problem of both the uterine cavity and intramural and subserosal fibroids.
Hence the importance of having specialists and professionals in women’s health in a clinic because we enter vaginally with a hysteroscopy that you have already seen in the videos, that is, with a tube, which has an operating shirt per vagina. Because she had a completely submucosal fibroid, that is, within the uterine cavity, approximately 3 centimeters as you will see in the video, and she had multiple fibroids, more or less 5, we removed in the intramural and subserous part.
The surgery begins.
Ok, let’s start, this is another surgery, yesterday we had one, this one has a submucosal fibroid, which Dr. Otto is using a hysteroscopic approach and we have multiple intramural and subserosal fibroids, we are doing it above and below the same surgical time, to try to, well, save us surgery.
We are already removing the first fibroid that we finished infiltrating, this is a fibroid that was in the uterine fundus, upper intramural third, so we already pinched the vascular pedicles, right now we are going to remove it and give the stitches, but we are going to be teaching surgery because it is very interesting. This part here is where the base of the submucous fibroid was, this whole area here completely obstructed the horn on the left side, and in addition to this we widened the uterine fundus a bit […] You can already see a much wider cavity and free.
Right now we are dissecting an intramural myoma, but it is all over the right lateral face of the uterus, attached and adhered to the large blood vessels that run through it, which is the uterine one. We have to go very slowly because here the danger is, obviously, hit the uterine vessels and cause us to bleed a lot, but it is very complex because this patient already had surgeries for an ovarian cyst and then an appendectomy, so she has multiple adhesions that also makes it very impossible for us to mobilize the uterus, it is very fixed and very attached.
We are already removing another intramural fibroid, this one was completely in the isthmic region but on the posterior side of the uterus. With the multiple adhesions it has, the approach is really too difficult, because of the anatomy the entire omentum and rectum are glued immobile, but well, we are taking off through a very small incision, with the idea of not messing with the adhesions too much, because if we mess with the adhesions we run the risk of intestinal perforation.
Right now we are attacking the pedicle or the vascular bed, obviously the incision is too small and that is what is making the approach a bit difficult for us, however, as we have always mentioned in surgeries, trying to make a small incision is in pro to a faster recovery of the patient.
That’s it, we’re done, really a two and a half hour surgery, almost three, due to multiple adhesions. The incision really four centimeters. Three large fibroids, but the difficulty with these fibroids was the location rather than the size.
Conclusions.
The idea that you are aware and watch these videos is that you know that at Creafam we can assist you in a multidisciplinary way, where we can do vaginal, abdominal, one-stage, two-stage approaches.
I also wanted to mention that this patient, what is the advantage? That in a single surgical procedure, with a single anesthesia, we performed two surgical events, that otherwise, if we go to a doctor who cannot perform a hysteroscopy, then he operates through the abdominal route, since it would be a cost for that surgery and then to operate through below would be a second cost, this considerably increases the monetary problem for patients.
In this circumstance, it was only a surgical event for the patient, a surgical time, because the three hours would not have taken us with the abdominal approach. In that period we did the abdominal and vaginal, but they were only a single payment of medical fees, then.
