Second case, a patient from Coatzacoalcos Veracruz, 34 years old, with a fairly large fibroid of 10 or 12 cm. She has not had pregnancies but had a little bleeding, menstrual pain and also some urinary urgency. This patient came to us because she had already been given medication, in fact we mentioned it in the video, medication to reduce her size.
One was an injection that all doctors know is goserelin or soladex, what it does is block the action of a gland that is at the base of the skull called the pituitary gland, this gland is responsible for stimulating the ovary. through two hormones; Fsh and Lh and what these two hormones do is that there is an ovulatory cycle, when there is an ovulatory cycle, estrogens are formed and estrogens are what feed or what makes these fibroids grow, so when we give these injections we block to the pituitary gland, we practically cause a kind of temporary or temporary menopause in three or four months while the medication is being applied. This causes the fibroid to decrease because there is no longer any estrogenic hormone, but there are also some side effects that can present as if they were a climacteric or menopause patient, but the most important thing: It is not always the appropriate indication, that is, putting this type of medications in addition to assessing that we are going to have bone demineralization of the bones and more so in a young woman, since it has to be very well assessed by the doctor.
I always tell them: Let’s see, if it is a patient in the final stages of her reproductive life, 47, 48 years old, who has a relatively large fibroid, has a little bleeding but no longer wants to have surgery, maybe it would be worth putting her in because she is already in the final stage of her reproductive life and also in the perimenopausal stage, but in a young woman it is not always the best indication to apply soladex, and later on this patient also received the esmya that we have already talked about, which is ulipristal acetate. What it does is an antiprostaglandin progesterone and it also inhibits the receptors at the level of the fibroid so that its size decreases.
In total, the patient applied 3 sessions of soladex, 3 sessions of esmya, she did not decrease greatly and ended up having surgery. Why did she mention it? Because many times when the medication is given, the circumference of the fibroid loses that differentiation of its capsule with the muscle and then sometimes it is more difficult to dissect that tumor, you will see it in the video because there is no capsule that delimits us and then We can take a little muscle tissue and sometimes it also bleeds more, in addition to the surgery being more laborious and taking longer.
Look, we already infiltrated it, it has too thick muscles, look at this here, all of that is muscle, but it is a fibroid that is bilobed towards the lateral sides of the abdomen, on the posterior side it has another smaller one. Obviously the incision is very small so we are going to have to do a digital dissection and then morcellate little by little but we will show it to you as the surgery progresses. Ready, look we still need about 60% or 70% of myoma. We have morcellated very little, more or less a 5 cm fibroid. But right now what we are doing is removing the blood vessels that cover the fibroid and the capsule, because here there is a half-degenerated area, not well delimited by the number of fibroids that fused to make the fibroids, as we said, it was bilobed, so we are Being very careful, due to the bleeding, right now we are going to remove this large piece and it will even allow us to see if we can remove part of the sample.
Ready, we’re done, but we wanted to show you a little so that you can see how well the tomography helps us, see the size of the tumor. The previous size is half bilobed, which are these white spaces that you see here, here you can see it much better. If we have imagination, this would be a fibroid, this is another one, and further up we see this entire tumor, see how it looks in the contrast, very well, then the uterus was behind, behind this fibroid, all this fibroid did was more towards the bladder and compress a little.
We finished, this patient preserved her uterus.