Single vs. Multiple Fibroids [Minilaparotomy Surgeries]
Visually, single fibroids generate a massive bulge in the uterus, while multiple ones give an appearance of “Sack of potatoes” 🤷♀️🥔👀 but… How different is the diagnosis, surgery and prognosis when removing a fibroid? or remove several?
Dr. Arturo Valdés, Creafam’s fertility expert, presents us with two cases, a patient with an individual fibroid and the other with multiple fibroids, with experience the recovery in both is excellent, so please remember: Knowledge is Success.
OK good afternoon. Once again we are going to present a video about a 35-year-old fibroid patient who called us two weeks ago from León, Guanajuato. We did the interview on Skype, today we did the surgery, a relatively easy surgery. Single fibroids, as I have always mentioned, sometimes tend to be a little simpler, especially if they are not as large or do not cover an important dimension of the anatomy of the uterus, but we are going to show you the video between one surgery single fibroid versus patients with multiple fibroids, in this video that we are going to upload the two surgeries will appear, both ended very well.
Individual fibroid surgery
How are you, good afternoon, we are here again with another mitosis surgery. She is a 35-year-old patient from León, Guanajuato who called us by phone and then made an appointment because the patient had a diagnosis of myoma of large elements for two years to date. . Her main symptomatology was that she had abundant bleeding during her cycles, accompanied by a little pain and also the sensation of a tumor when doing some physical activity. This patient spontaneously had a child up to 18 years of age, but obviously she wants to get pregnant again. This is the incision that we are making, it is really very small because what we want is for it to remain aesthetic and the fibroid is a single, intramural fibroid, anterior fundic face. We will try to make it as simple as possible. We are going to proceed to infiltrate the fibroid.
It is always important to try to be in space, although on many occasions when infiltrating (It has already become hard, look) The fibroid begins to become a little more solid, harder. Ok, now we are going to start the surgery, we have finished infiltrating and we have already grasped the fibroid, obviously it is a little difficult to visualize it, because the incision we made is too small, we are making a little cut before and after the musculature, but nothing more to give us more space in the womb. The musculature is all this thick that is seen here, this is the serosa, that is, the peritoneum that covers the uterus and we enter the space of the fibroid, so this is very easy because what we do here is make a digital digit. To be doing the extraction of the fibroid. We are going to proceed to morcellate the fibroid a bit, that is, making an incision like a zig zag with the intention that it can exit through this cavity, because we made an incision that was too small, precisely with the intention that the surgery would be very fast depending on the recovery, obviously the most important thing here is that you’re not bleeding anything.
Okay, we’re done. Here’s the pedicle with the capsule, it’s this part here. Here is the tumor. It’s obviously circular, it’s a 10 centimeter fibroid more or less that we did half morcellate so it could come out. And see how the vascular pedicles are pinched here. He’s not bleeding at all, in fact he hasn’t bled at all. We are going to start giving the hemostatic stitches on the pedicles of the fibroid… Well, from what the fibroid was, there is no fibroid anymore.
Actually, well no, he’s not bleeding. We cannot remove the uterus as on other occasions because the incision was too small… Let’s see if we have a little bit of hydrogen peroxide that we can add here.
Ok, we’re done. The surgery really took 45 minutes. The incision is three fingers wide and the fibroid is more or less than 10 centimeters.
Multiple fibroid surgery
Good afternoon, we are here again for a new fibroid surgery, but look, we have this patient. Unlike the other surgeries, this is a patient with the classic uterus that we say in “Sack of potatoes.” It has 1, 2… A bigger fibroid here below 3, it has a pure subserous fibroid that measures more or less 10 centimeters that goes to the right flank 4, it has one on the back side 5… So right now we are going to start to infiltrate, it will be a slightly more laborious and time-consuming surgery. But I do want you to see it so that later you can look at this myoma, how beautiful it looks. This is a subserous myoma, but it has a little intramuscular, intramyometral involvement.
We have here an intramural fibroid and we have this pure subserous. As I sometimes told you in the videos, the pure subersoso is like a mushroom, a medium thick base, well vascularized. So, let’s start infiltrating. Take a good look, we already removed the first fibroid that was purely subserous, but look at the piece of base that has a pedicle here. It is very important to first infiltrate, then make the hemostatic stitches and then remove the fibroid and we are going to start because it is a uterus with multiple fibroids and in addition to very large elements.
- On the contrary I move him.
- Really, those three that we have taken are insignificant compared to this little monster that comes here.
See this monster as it is. It’s linked (Give me a long dissection) It’s linked, right now we’re going to post it. Anatomically obviously the uterus is not visible, but look here, here we have the fallopian tube. This fibroid comes out of the uterine horn practically from the left cervix. Pure subserous, but look at the large number of blood vessels it has, it is very important right now to vascularise this first, put vasopressin in it and then ligate and then remove it, but it is a pure subserous, they are sometimes unpleasant, ugly, amorphous, but they have many blood vessels .
We have already removed 2 subserous fibroids, right now we are infiltrating the one on the posterior lower third of the uterus, so we already put a compress, the cavity gave us permission and right now we are infiltrating the intramural one, after this there is another one there on the right lateral face and then I think there are two left in front and back, and we’re done. Look again, another fibroid, usually subserous but this one has a stalk the size of three centimeters or so in diameter. You have to infiltrate very well.
The problem with this fibroid is that it has another one behind it and that’s why I think it’s so big, I’m going to see if I can get the other fibroid out so it can be seen. No, it’s not enough… There it is, look, there’s the other myoma, the tumor. So, practically this patient made all of her fibroids outwards and as she told you, the problem with subserosals is the pedicles, we are going very slowly. Ok, we’re done, she just wanted to show you all the fibroids we removed. We removed the three subserosal and the intramural ones were a little smaller, so it was relatively easy, but there were 3, 4, 5, 6, 7, 8 fibroids. But look at the incision, that is the advantage of making a small incision, it is a bit laborious, but this patient will be able to leave tomorrow and right now if we close with a subdermal.
I want to remind you, sometimes we are asked what is the difference between a laparoscopy and an open surgery? We make a minilaparotomy, that is, incisions between three or four centimeters in length, so practically the recovery is very similar to a laparoscopy with a minilaparotomy. The difference is mainly that, in a laparoscopy, the surgical time can be prolonged a little more due to the difficulty of the stitches that must be given to the uterine body there, but the most important thing is the cost.
Generally, they tend to double the cost of open surgery, for obvious reasons: one for the longer use of the operating room, two for the apparatus and instrumentation of the laparoscopy, and three for the morcellator. So, on many occasions we are limited to perform laparoscopies.
Call us at Creafam, we are here to attend to all patients who have a second opinion on myomatosis or those who want to come for surgery. The little patient comes from León, she arrived today, she leaves tomorrow, a one-hour surgery. Creafam is with you.