Look then, we wanted to show you, I had already told you about a program that we downloaded to see the same image of the tomography but three-dimensional ourselves and that is going to give us an orientation, see, this is a cut between sagittal and frontal but I wanted to show you why It starts like the thigh of the leg, this would be the pubis, this is the abdomen and here is the umbilical incision, look at the umbilical scar and this part here is as if we did not cut from the hip. So what do we do with these types of patients? Well then we visualize all the images to be able to have a better idea, if I am going to drag it, see here is the head of the femur, the femur goes down here, this is the part of the tail, then we are making the cut, we are moving , we are moving, the spine appears and here is the tumor, see, here you see the tumor, that tumor moves upward because remember that this surgery had a tumor and above it had two other fibroids.
The most important thing about this is that with all the technology we have we can give ourselves a very big idea. Here is the uterus, see, here is the uterine cavity, then this is the column, here it descends, comes the sacrum and comes the coccyx and this is the sigmoid rectum, but here is the cervix and then this is the uterus and we know perfectly well that It is on the anterior surface and also moves upward but does not involve almost anything in the posterior surface of these uterine muscles. So, when we see this type of surgery or tumors, what we identify is: Here is the umbilical scar, so many times I tell the patient that the limit is the scar, above the umbilical scar we generally make a middle cut of the navel towards the pubis more or less 8 or 10 centimeters because the separator makes a gap of approximately 20 centimeters and we can maneuver perfectly, you will see it in the surgery.
So, when we have this type of images, the decision of mid or pfannenstiel surgery, which is the one in the bikini line, depends a lot on the size of the tumor or tumors that we have, or if they are subserosal or intramural, in The patient from Colombia had a fibroid that went above the scar, but seeing that it was completely subserous, we did make a pfannenstiel aesthetic incision, which is in the bikini line because we were not going to struggle to make the resection. Not in this patient, in this one we had to have a larger field because it was not a subserous fibroid but rather an intramural fibroid with a little bit of subserosal components. So, the most important thing is: Imaging does serve us for the surgical approach and for the prognosis of that patient, beforehand, that is, informing them what we are going to do, how long it will last and what risks we have. We should not stay with the idea that they tell us that because if it is large, the uterus has to be removed, because in many cases, like the one in Colombia, it was pure subserous, then this fibroid is intramural but has more of an outward component. that went to the uterine muscle and they will see it in surgery.