3 giant fibroids

They almost never put it on school diagrams, but in reality the uterus is surrounded by ligaments, uterine and ovarian arteries and the mesosalpinx that helps keep everything in place… One of the giant fibroids in this video weighed 1.8 kilos and it was located right in this area comes with complications.

Also, if you have fibroids, Dr. Valdés will talk to us about the development of a new system about to be launched, a fibroid catalog style, to find cases similar to yours so that you can understand your own fibroid before undergoing any intervention or treatment.

Schedule online and receive a discount on your first consultation.


Hello, how are you, good afternoon. Look, today it occurred to me to put this video because we had three major myomectomy surgeries and we are in a very interesting project to help you, all the patients who have called us and asked us for a second opinion both by Zoom or in person about the characteristics of fibroids, the surgical time, they will even be able to know how much the cost may be and also watch the video based on what you told them: What type of fibroid it is or what it will be the type of surgery that can be performed on them or that can be performed with us. Remember that knowledge is power.

About these 3 patients

So we are going to divide… The three patients that you are going to see are very interesting because recently the work that we are going to do is 106 patients that we did with myomectomy surgeries but it was in a period of time, because how is it going to be a job? Also that it is going to be advertised in an obstetrics and gynecology magazine, obviously, we only had to do a certain number of patients, but now we have more than 150 fibroid surgeries based on that research and it is very interesting what we have found each time. further.

These three patients, one is from the State of Mexico, another is from Puebla and another is from Chile, yes that’s right, fortunately we have a lot of international surgery and a lot of Zoom consultations from international patients and so the three are very similar. One patient is 40 years old but the other is a young girl of 26 and the other is 31 and the three patients have large element fibroids but I am going to upload them because the three surgeries, although they are large element fibroids, are completely different in the approach technique. because one is a subserous intraligamentary fibroid, that is, it is outside the uterus, we did not touch the uterus at all but surgically it is very complicated to do this type of surgery and it was a tumor of more or less 30 centimeters that weighed one kilo 800 g. I more or less finished remembering and yesterday I did two surgeries, the one from Puebla, a little patient who has a fibroid with large elements of about 10 or 12 centimeters but it was submucosal, that is, it was in the cavity but we had to do the approach from above. the surgical size and the last patient, the one from Chile, is a patient whose tumor weighed 2 kilos 500 g. but it is a pure intramural one and then we already have the three types of fibroids: The subserous, the submucous and the intramural and the three with large elements.

Myomectomy or uterine fibroid surgery

We are going to start a myomectomy on a patient from the State of Mexico, she wrote to me on Zoom because she wants to get pregnant but she has a giant fibroid with large elements, apparently completely subserous, right now they are going to see it but look at the size of the tumor and we are going to do it a supraumbilical midline to have a better surgical field.

Ok, look, we managed to put Alexis’s separator in place, but look at the piece of tumor we have inside here, we’ll show it right now. This is the uterus, see, here is the completely preserved uterus, it probably came from the side of the left tube in the ligament, so there are going to be a lot of large vessels there. We are now removing the vessels because what she did is that she got into the mesozalpinx, so this whole area is very vascularized, obviously it goes towards the uterine that is here, this is the uterine on the left side of the uterus. So the idea is that it has embedded itself towards what is the vagina, so we have to first detach all the large collagen vessels so that they can clear us. We are removing the entire peritoneum, this would be what the mesosalpinx is, it is there, that is why the large vessels but we are, as they say, decapsulating it with the intention of not messing with the vessels that are there in the uterus and then seeing how we get into the hole pelvic. This is a large vessel, we obviously have to coagulate it but the tumor is already coming out and apparently we are going to completely respect the uterine anatomy except the uterine on the left side, I think that it will not be able to be saved but it does not matter because it only irrigates the 40-45% of the uterus. See, I wanted to show you before removing the tumor, see this is the posterior uterine surface, the right ovary, the right tube, the left tube with its ovary but we are stuck here, look, this is the round ligament, we are stuck here, here it is all the vascularity, we have to remove it from the uterus without bleeding so much but we are practically almost done with the surgery. See, we’re done, we wanted to show you how the uterus turned out, see here is the round ligament, the trumpet, its ovary on the left side, the ovary on the right side, the tube and the uterus, see, it really turned out better than we thought because it wasn’t So elongated, the uterus is very beautiful and she will surely be able to get pregnant in a month, not in about six months.

Let’s start, a little patient with fibroids, it is a single intramural anterior fibroid also with a subserous component, she is barely 26 years old and has never been pregnant. It is already turning white at the moment we begin to infiltrate, the idea is always: The more we prepare the fibroid before making the incision, the less bleeding and obviously the idea is also a small incision in these patients who are young and have a good reproductive prognosis. . Look, we have already managed to externalize, see how ugly this muscle is because remember that fibroids are generated from the uterine muscle, this is degenerated muscle and it is more or less hyaline but the uterus is here, right now we are going to resect it and show you how it looks in the end repaired the uterus.

Ready, look, we’re done… A grapefruit, 10 centimeters or so and now we’re going to repair the uterus. How beautiful the anteroposterior incision was, as the canons say. Here the ovary is always on the right posterior lateral side, left beautiful ovaries, the fallopian tubes how they hang and we wanted to show you: See how it turned out, like a rooster’s crest, we gave several transductive points due to the size of the tumor but the uterus was very good.

Ready, we are going to start the second myomectomy, this is a patient from Chile who wrote to us, she arrived yesterday, she is only 31 years old but look at the size of the tumor, it is very similar to the one we removed from 10 kilos of a patient from Colombia . Let’s see if we can preserve the uterus because it is very infiltrated, see we are morcellating because obviously, although we made a medium and large incision, it is a tumor that is too large, very unmanageable and the idea is that it does not bleed, so we are going to morcellate one part and now we show you the other morcellation. Look, we already managed to get it out, see what beautiful polycystic ovaries it has, the tubes are here, this is the body, posterior bottom, it would be anterior and we opened like this because it was completely turned, here the difficult thing is we are going to have to open this way so that we don’t Let’s get to the horns, which is where there is the most bloody area. Look closely, we are done but obviously the uterine reconstruction is going to be very difficult, very complicated, we will surely have to ligate the uterines.

Fibroid catalog or search system

More and more we have patients with large element myomatosis, who in the period of time that they are presenting, more or less it is between two or three years where they begin to have symptoms. At work you will be able to find out what the three main symptoms are, which are basically bleeding, obviously menstrual pain which is dysmenorrhea and constipation or urinary urgency, that is, they feel very inflamed or have the urge to go to the bathroom very often. So, first what we are going to do is upload all the information we have in Excel about the characteristics of fibroids, the types of fibroids, the numbers of fibroids per patient, how long the surgical time is, what are the characteristics of the patient symptoms; Bleeding, dysmenorrhea, constipation, urinary urgency, which patients were anemic or not. We break it down in this work by patients who did not have anemia before surgery, patients who had mild, moderate or severe anemia, the surgical risk of the patients, the surgical time, who received blood and who did not, and the characteristics of the surgery. surgery. We have been emptying all the information and something very important, for example, patients who have mild anemia have a two-hour surgery period and patients who already have moderate anemia before surgery due to bleeding from those fibroids or because they hijack the the fibroids bleed, their surgery took three hours. In patients with mild anemia we only gave them about one packet of blood on average per patient.

Many patients will think that size is the most important thing in fibroid surgery, but no, what we are observing is that patients who have mild anemia… First, the surgery takes less time, on average two hours, and they are also not blood passes and they do not have hemorrhage either, that is, on average, patients with anemia bleed 200 milliliters from the surgery. Patients who have moderate anemia already have more than 500 milliliters of bleeding, they already have to put a blood pack on average per patient and in addition the surgery takes three hours or we are late, that is, it has already increased by one hour more surgery, just because it is a mild or moderate anemia and those with severe anemia increase that risk even more. The longer the surgical time and the more bleeding, the greater the probability of removing the uterus. In fact, we only remove the uterus from the patients with mild anemia, while we remove the uterus from four patients with moderate anemia.

They will be able to extract this information and see that patients with moderate anemia obviously have more menstrual pain and more bleeding, which is why they have anemia. Look then, here what we are really looking at is the age of the patient, the average age, the body mass index to see if it is more frequent in thin patients or in obese patients, whether the patients have already had pregnancies or not, because Note that 40% of the patients with moderate anemia, that is, 4 out of every 10 patients, have already had pregnancies, that is, we have the idea that the patients who do not get pregnant are the ones who have more fibroids, but it is not true. , also 40% of the patients have already had pregnancies. Patients who have constipation or bleeding, look at moderate anemia, 80% of patients have menstrual bleeding or hemorrhages, while patients who have mild anemia, only 50% means that the more anemia there is, the more bleeding there is during the cycles. menstrual periods and therefore that patient with moderate anemia will have more fibroids.

So… Excuse the emotion for so many statistics but the thing is that as we do the work we even learn more about what we do in surgeries and the interesting thing is that you know that you will be able to get on our page, we know that many patients They go to an ultrasound in some town or in a laboratory, they do not even have contact with the doctor and they are diagnosed with myomatosis, they are scared thinking that it is cancer or that they will no longer be able to get pregnant or they were told that they were going to remove The uterus.

The idea is that you enter your case and since we have performed more than 150 myomectomies in this period of two years, the truth is that we are going to have specific or specific information for your case, where you can enter your characteristics or your diagnosis and It will appear how many fibroids there are or what characteristics they have and even, you will surely be able to find a video about the fibroid very similar to yours and you will be able to know that it is surgical, that it is operable and that it is not necessary to remove the uterus. So, please keep a close eye on this page.

Many patients will think that size is the most important thing in fibroid surgery but no, what we are observing is that anemia is a major factor in preserving the uterus.

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