Good afternoon, we are going to start another myomectomy, a little patient is coming… Where do you come from?
From Morelos, Cuernavaca and look how he has his multilobed myomite here, there are multiple fibroids but look how far it goes, to the scar, a little bit below the umbilical scar. That is like the limit that we set to see if we open with a pfannestiel incision or with a medium incision, in this case it is at the limit, we will make a half… I say a pfannestiel, a little more enlarged but remember that with the separator Alexis always allows us to perform more aesthetic surgeries and with a fairly regular or wide operating field.
He has a fibroid, this one that we are infiltrating is a subserous fibroid, very little intramural, in the background slightly loaded I think towards the posterior surface because really right now we are going to discover when we take this out, he has multiple small fibroids and – We are going to remove the finger Dr. Otto – Look, this is the main fibroid but if we look at the uterus here, here you can see the uterus but anterior here it has another look, a little bit in the anterior isthmic region bilobed, here there is one, another, a subserous and That side also has others… Actually, it is quite a fibroid, or a rather ugly, myomatous uterus, with the classic sack of potatoes. The ideal is always to start with the easiest one, but it is also true that we should start with the largest one, preferably so that it allows us, once we remove it, to work on the surgical field. So let’s start with the big one and then go to the previous one.
Ready, we removed the first fibroid – hand me the fibroid – It was a completely intramural fibroid and through that same hole we removed a smaller one also intramural on the right lateral side, but this is the intramural fibroid. How do we know it is intramural? See, all that is the muscles, all this here, we already gave the hemostatic points there.
We are already removing the one from the posterior side, in fact the uterus had to go to the right side, towards there, but see this is very important because in the same tomography that the doctor will show you shortly, there is a slightly rounded area, hypoechoic, but it is because the fibroid is calcified, see, that is, it has as if it were bone incrustations, which is not bone obviously, but this fibroid is well calcified, see, well classified, the infiltration was difficult because it is almost a stone. Well then, let’s start removing it, it is in an area on the back of the entire broad ligament where it is full of blood vessels but we have to go like almost all the others we have done, very carefully.
We’re done, look how curious, because this fibroid looks even half pale yellow because the encrustations here are hard, see, that is, it’s hard, this seems to be as if it had been done… That’s why it’s called calcifications, like dried lime , but we had never had a calcified language, now we show it to you in the CT scan.
Look, we’re going to finish, this is the last fibroid, we left it because it was the most difficult, this part here is the endometrial sac, that is, here is the endometrium, the cavity but I wanted to show you because this patient, when Before putting it in today, he went to the consultation because he brought his CT scan and the CT scan did not make it very clear to us if it was in the cavity or not. It’s not there, but that’s why it seems like it’s completely protruding into the cavity. Right now, it’s clear how it is in the menstrual cycle, because there is a little bleeding, but what we are going to do is resect it, try to leave at least a little fibroid but preserve the most important thing, well, its endometrial cavity bag, which is this part of here.
Ready, we’re done, look here are two of the largest fibroids. This is the fibroid that was intracavitary, well, close to the cavity. This is the other fibroid that was bilobed on the posterior surface and these are the ones that were anterior, and the calcified one. See the difference between this calcified fibroid, which in fact now is almost a stone! Compared to these, look, does it come out? and the incision was really very nice so we were done.