Maybe this surgery or this fibroid would have been perfect to have been done laparoscopically and with morcellation, however, morcellation can also have its risks of bleeding and mainly that a surgery performed laparoscopically with a morcellator is more expensive, so many patients prioritize Having a lower cost, at the end of the day from a reproductive point of view, if we do a careful and clean surgery, it will have the same reproductive prognosis as laparoscopically.
Sometimes we are asked about fibroid embolization. It is very important that embolization is recommended for very specific cases, I always tell them very similar to medications: Embolization, patients in the final stage of reproductive life with perhaps a fibroid or two and who are not older than 5 or 6 centimeters, so that there is not so much bleeding, if it could help… But if it is not in the final stage of reproduction, then the patient will continue to increase her tumor and especially if it was already a fibroid of origin greater than 7 centimeters or 8, it has very few indications. It is too expensive, embolization has a cost very similar to a laparoscopy precisely because it is a non-invasive process, much more sophisticated, complex and then the results depend on the patient and the fibroid, but they are not as encouraging and that is why it is It has been decreasing today in surgical techniques and especially in the reproductive stage. The ideal time for surgery is generally after bleeding, but many times patients with fibroids have constant bleeding, so it is very difficult to know the time of the cycle, sometimes what we do is put them on contraception, but in foreign patients the truth is Well, it doesn’t influence that much, it’s more in the times that they may come, but yes, ideally it would be when she is not in her menstrual period.
Look closely here is the base, it is a pedicle that is too thick, it is literally attached apart from the musculature of the uterus, but many times the key here is to leave a little capsular tissue because it is attached to the great vessels. The large vessels are connective tissue that cause fibrosis and that is what can complicate bleeding surgery. We better choose to get along, taking out those little glasses, lowering them, lowering them and obviously the need to avoid bleeding. We already finished the surgery but this is all endometriotic tissue. Endometriosis is, we will talk later, it is a very constant and very common inflammatory tissue in reproductive patients and in the fertility stage, but the entire right side of the uterus, that is why we are half removing it… The uterus is large so it is not It comes out, later we are going to show them, but it has a very large hole, there is some bleeding, we have to give some hemostatic stitches and deal very well with that hole that was left in the posterior face of the uterus.