Removal of a fibroid [4 inches, intramural]

Today in #KnowledgeIsSuccess Dr. Arturo Valdés explains how he arrived at the diagnosis and extraction of this posterior fundal intramural myoma of 10 cm ⚠😷⛔ Caution, graphic content

Fibroids are usually benign tumors, but they can cause lumps, anemia, irregular periods and therefore fertility problems.

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About the patient and the diagnosis.

This little patient came two weeks ago, 46 years old, she and she had a child in 2008, so her idea was not for reproductive purposes. She simply realized that she had a sensation of a tumor since her abdomen had increased in size and sometimes, in some cycles she had certain irregular spots. So, she came for a fifth opinion, the patient had seen 4 doctors before her and they had mentioned that they were going to remove her uterus; one for her age and two for the size of the uterus.

It was a fibroid or is it an intramural fibroid that was completely in the muscle of the uterus, but in the upper part that is called the uterine fundus and at the back. It was a posterior fundus, so when making the assessment it was a single 8 cm fibroid. to 10 cm. with a fairly accessible diameter and also very easy… Apparently, the patient underwent surgery, or we operated on her yesterday and you will see it in the video, it is very easy to remove with surgery, but the most important thing about this fibroid is that it was a fibroid with a cystic consistency, that is, half soft, half gelatinous, but it was perfectly clear how the capsule of the fibroid was and when opening that capsule inside the tumor.

The surgery begins.

We are here with a 46-year-old patient, who already had satisfied parity, but she came to the consultation for referring a little cyclical alterations and with a history of diagnosis of myomatosis of large elements, so when we checked her in the consultation we have a fibroid unique, intramural in the posterior face and right now we are already infiltrating with vasopressin to have a vasoconstrictive effect and to prevent bleeding. Remember that we always have to wait between 5 and 10 minutes for the vasopressin to take effect and right now we are going to show you the surgery.

Look, I’m going to show you something very interesting. We are here “clamping” with the tweezers to pull the fibroid, but look, father, you can see what the capsule of the fibroid is, which is this part here. Look, we can even detach it and the cystic tumor , solid cystic medium of the fibroid, is a very soft fibroid, which will allow us to make a good digital dissection and with a safe bleeding slightly less than 100 milliliters. I think we bled a little more from the cavity in the wall than here from the surgery. We’ll show you more later.

Take a good look, we already placed the first clamp on one of the vascular pedicles of the fibroid, this is almost over, but it is very important that we make the pedicles with good hemostasis to avoid bleeding. Actually, when the fibroids, as I was saying, only large fibroids, but which have this cystic-solid consistency, are sometimes very easy to remove, the only joke or the only intention is to avoid bleeding, because sometimes they make layered bleeds, which They can lead to a little considerable bleeding if we don’t take care of them. Ok, here I wanted to show you why we are giving it 3, 4 dots, because the pedicle is a little long and also reaches the uterine cavity. Obviously, in this patient, there is not so much of a problem with respecting the cavity because she no longer has a desire for fertility. . The doctor already ripped it off. We’re done! Any questions? No… It was really too small, and that’s why it came loose.

Babcocks are generally widely used in general surgery, mainly for the appendix or even for the gallbladder. We gynecologists don’t use the Babcock so much, but on this occasion using the Babcock helps you not to dramatize the muscle so much, much less what the serosa of the uterus is. Look how cool it looks, we haven’t closed it yet, here we have the round one, here we have the uterine tube and there at the bottom is the left ovary, it looks very white, very small, because she is a 46-year-old woman. Here is the right ovary, the tube and in the round, so this patient had a previous caesarean section, here you can see a little bit of the healing, this is the anterior face, the fundus and the incision is posterior to the fundus. When we do the surgery we open, in fact the video shows how a small hole remains. We join with a few points to face that gap, but then we cross the uterus from side to side, that is, we enter through the anterior face, we cross it to the posterior face and what we do is a point that is called transductive, with the intention that that uterus to be crushed more, to be pressed and not to bleed.


When the surgery is over, we see a uterus more or less like this, which has irregular edges, like a rooster’s comb, as I mentioned. But it is very important, in the process of healing and regeneration of the uterus, later what will happen is that the uterus will return to its structure or to its proper anatomy, that is, it does not affect the posterior uterus both to get pregnant and to have some problems or bleeding or menstrual disturbances. So, the idea is that the patient finds out, keep writing, keep calling, keep asking questions on Skyp

“We can make the first assessment via the internet, even this week I had a patient from Honduras and another from California, where they send me the images via wats or by mail, I see them and we are talking in real time”

Dr. Arturo Valdés
Dr. Arturo Valdés
Reproductive Medicine and Gynecological Endocrinology
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