7in Uterine fibroid in the right horn
When a large element fibroid compromises a tube and also invades the uterine muscle, surgery requires a team of specialists with the flexibility to modify procedures at the moment.
This week Dr. Arturo Valdés presents us with two very different cases of myomatosis, the first extremely complicated and the second very simple.
Good morning, we are here again with you at Creafam, now we have changed cubicles, we are in the psychology and nutrition office, but I wanted to show you two other fibroid surgery patients again.
We return to this topic because we have more and more consultations from patients with myomatosis thanks to these videos that we have been uploading and that we hope will continue to be didactic. Our first patient is a 35-year-old patient who lives in Amecameca in the state of Mexico and wrote to me online to make a consultation, sending me the results and she is a patient who has not been able to get pregnant but she had a tumor that was felt by Above the umbilical scar, then really her main problem was that this tumor already made it difficult for her to do activities like running or jumping or the same sensation of feeling very full and she also had symptoms of urinary urgency. She couldn’t stay for a long time and she constantly wanted to go to the bathroom. When doing the exploration and assessment, it is an intramural fibroid also inside the muscle of the uterus, but it was more subserosal, that is, it was more towards the outside of the uterus, however, you will see it in the video, when we entered the surgery, I think that the evaluation fell a little short.
The fibroid actually measured around 18 to 20 centimeters in length and was directed towards the patient’s right horn, that is, more or less, I always explain as if the horn were the shoulder of the uterus and the right tube was the arm, so it was stuck or anatomically towards the right horn where the large uterine and tubal vessels are located and then the surgery was somewhat difficult, because when beginning to resection the fibroid there was no differentiation between the muscle and obviously the tumor because it was located in that anatomical part . We began to do a resection and then we detached the muscle but the musculature of the visceral peritoneum was slightly, let’s say, exteriorized or detached, that is, what covers the uterus and tube. We had to do a little bit of reconstructive surgery at that level, but we were able to remove the entire tumor, obviously it took us a little longer.
The bleeding was 300 milliliters, it wasn’t a big deal either, but if her approach and her surgery was a little complex, a little more difficult than the previous ones that we have shown, why am I telling you this? Because it is important that this type of surgery is done by people who have a lot of practice, because that is where a process can be complicated and have the ability to make a resolution and solve the intraoperative problem, mainly avoiding bleeding and second obviously avoid removing that uterus.
We have finished infiltrating, right now we are making the median fundic incision, to go through the fibroid, obviously it is too large a fibroid, which slightly displaces the right horn towards the posterior lateral part. What we’re trying to do is first make the incision. It is a slightly hyaline fibroid, it is not so solid. There is the musculature, but there is no capsule that separates the musculature from the fibroid, so it is a little infiltrated towards the musculature. These fibroids are a little more difficult to resect because there are intramural connecting fibers with the tumor. We are giving a small morcellation because the tumor is really too big, so in order not to open the scar further, what we do is make a kind of zigzag in the tumor to be able to remove it. Here we already removed the fibroid, it has a large pedicle, since it is intramural subserous, but we are going to start putting the clips on it… the clamps to prevent excessive bleeding, because it really is too much, too big and very vascularized fibroid obviously. See the uterus, here is what the planes are, although there is not a very good respect for the planes. Right now we’re going to remove it If it’s great It’s bigger than the last one Ok, we’ve finished the surgery… And so I wanted to show you why it really is a very complicated and very difficult surgery, the fibroid started on the anterior face and uterine fundus, but it infiltrated the entire area of what is the right horn. Here is the tube where, when the fibroid was resected, well, obviously a little blood began to infiltrate, but the tube, the ovary, we’re done. We really gave a lot of stitches but the surgery is over. The patient stayed one night, she left the next day, I just saw her this Saturday and she progressed very well, in fact there is no longer any irregular scarring. The uterus looks a little enlarged, but those muscular and scar edges are very well addressed.
The second patient, who is another fertility patient of course, but she is she is 40 years old. She came mainly not so much because of the issue of effectiveness, but because this patient had symptoms, let’s say hematological, that is, her anemia that produced this fibroid. She had abundant bleeding each month in each menstrual cycle, but also, she already felt dizzy, she was agitating a lot, which is a tachycardia of medium or small efforts to the patient, even bathing or changing her clothes caused her a little tachycardia and dizziness, sometimes sometimes cold sweating and on many occasions she would get very dizzy if she got up suddenly, then, when making the assessment, it was an intramural fibroid on the anterior side of the uterus.
The surgery is very simple, you will also see it in the procedure, this patient took us 25 minutes to remove the fibroid and from the time we started to the end of the surgery it took just 40 minutes for the surgical process. We always leave them overnight because patients must be ensured that they do not have symptoms of abdominal distension, that they tolerate the oral route and the most important thing is to give them painkillers through the vein and that they are as calm and without any discomfort, and most importantly is that they do not delay an adequate diagnosis and especially if a surgical process is necessary, since we are trained and have all the experience to resolve your case. We invite you to Creafam. Creafam. The experts in fulfilled dreams.