Good afternoon, here we are again with a myomatosis surgery, apparently it is a single intramural fibroid that invades the anterior cavity. The patient is 45 years old, she is from Veracruz, Coatzacoalcos. But it came mainly because of the problem of anemia, so this patient has a hemoglobin of 8.8 even though she is receiving hematids, so the intention of the surgery is obviously to eliminate the bleeding problems she has and we are making a mid-incision because she already has 2 previous cesarean sections, she doesn’t want to remove the uterus, so we are going to try to do a simple myomectomy surgery and preserve the uterus.
Very good, she look she wanted to show them. Here we have the Babcock clamp, see how good the muscle tissue looks, this is the musculature, this is the visceral peritoneum but the fibroid is all degenerated, see how the degeneration is like hyaline cystic, it is watery, in fact it is falling apart because he is patient, or it is a fibroid where they gave him some medication but it is too, too degenerated. Let’s take it out, the advantage of this is that it is too easy to take out through a relatively small incision in the uterus. We must remember that she no longer has a reproductive desire, so that gives us a certain advantage of not worrying about the incision we make in the uterine muscles.
We have already finished removing the fibroid, I wanted to show it so you can see: This is a degenerated fibroid, you see it does not have a capsule at all and obviously its consistency is soft, sebaceous cystic, somewhat irregular and ugly, so, you have to see the muscles, it may be You see the muscles, but inside there are semi-irregular lesions where there is no capsule, but right now we are going to give some coping points so that the bleeding stops. Well, here we are, see, this is another intramural myoma, but this one is on the posterior surface.
Here is the ligament, well no, this is the tubal, the uterine tube, so it is a very vascularized area but it is a smaller fibroid. See this, we already infiltrated it, we are going to make a small digital digit to remove it and grab the pedicle at its base so that nothing bleeds from us. Remember that in that area you always have to be very careful about bleeding and do good hemostasis. It is just the last fibroid, see this is a subserous fibroid, just like what we have always mentioned, the problem with subserosal fibroids is their great vascularity. It has a pedicle that is more or less thick, about a centimeter in diameter, that is where we are going to infiltrate and we are going to remove it, we are done.