How are you, good afternoon. Just for introduction, we have already seen several types of fibroids, there is solid fibroid, cystic fibroid, hyaline fibroid, degenerated fibroid. Among these four, the vast majority of fibroids move, but a percentage of at best 5% or 10% are in fibroids, which are solid or harder than solid fibroids, which is called a calcified fibroid, this is because Salt or calcium incrustations are generated and that is what we want to show you below.

Ok, look. You have to remember, fibroids, then I get asked a lot: Is a cystic fibroid more dangerous than a hyaline fibroid or a degenerated fibroid? Yes, there are differences a little at the time of surgery because the cystic fibroid is generally softer, it has the advantage that we can easily remove it through smaller incisions but sometimes this type of fibroids, although contradictory, are sometimes a little more difficult to extract if the capsule breaks. The disadvantage of degenerated fibroids, as we have seen in some surgeries, is that they often infiltrate or lose the compartment or differentiation between the fibroid capsule and the muscle and then they are a little more bleeding, these tend to be a little more bleeding. Solid fibroids normally struggle to infiltrate vasopressin but they are fibroids that, unlike cystic or hyaline fibroids, sometimes bleed less than degenerated or cystic fibroids.

Specifically with this case that we are going to present of calcified myoma, the advantage it has is that it does not bleed much because precisely those small incrustations, imagine that it is filled with tartar, so to speak, with calcium, they make its walls a little more stony or harder but there is also not as much vascular irrigation and so it is easier to remove with a little less bleeding and the only difference between all of these is that the degenerated fibroid or the hyaline fibroid are the ones that sometimes could have there is some implication there of risk of some cancer of that fibroid, but it is the least. Actually, the cancer or sarcoma that is called the site of the uterine fibroid is exceptional, we already had a case but in 13 years, so the most important thing is that they come, have a good evaluation, a good review and obviously have a good context between a solid, cystic, hyaline, degenerated and/or calcified fibroid.

Good afternoon, we are going to start another myomectomy, a little patient is coming… Where do you come from?

From Morelos, Cuernavaca and look how he has his multilobed myomite here, there are multiple fibroids but look how far it goes, to the scar, a little bit below the umbilical scar. That is like the limit that we set to see if we open with a pfannestiel incision or with a medium incision, in this case it is at the limit, we will make a half… I say a pfannestiel, a little more enlarged but remember that with the separator Alexis always allows us to perform more aesthetic surgeries and with a fairly regular or wide operating field.

He has a fibroid, this one that we are infiltrating is a subserous fibroid, very little intramural, in the background slightly loaded I think towards the posterior surface because really right now we are going to discover when we take this out, he has multiple small fibroids and – We are going to remove the finger Dr. Otto – Look, this is the main fibroid but if we look at the uterus here, here you can see the uterus but anterior here it has another look, a little bit in the anterior isthmic region bilobed, here there is one, another, a subserous and That side also has others… Actually, it is quite a fibroid, or a rather ugly, myomatous uterus, with the classic sack of potatoes. The ideal is always to start with the easiest one, but it is also true that we should start with the largest one, preferably so that it allows us, once we remove it, to work on the surgical field. So let’s start with the big one and then go to the previous one.

Ready, we removed the first fibroid – hand me the fibroid – It was a completely intramural fibroid and through that same hole we removed a smaller one also intramural on the right lateral side, but this is the intramural fibroid. How do we know it is intramural? See, all that is the muscles, all this here, we already gave the hemostatic points there.

We are already removing the one from the posterior side, in fact the uterus had to go to the right side, towards there, but see this is very important because in the same tomography that the doctor will show you shortly, there is a slightly rounded area, hypoechoic, but it is because the fibroid is calcified, see, that is, it has as if it were bone incrustations, which is not bone obviously, but this fibroid is well calcified, see, well classified, the infiltration was difficult because it is almost a stone. Well then, let’s start removing it, it is in an area on the back of the entire broad ligament where it is full of blood vessels but we have to go like almost all the others we have done, very carefully.

We’re done, look how curious, because this fibroid looks even half pale yellow because the encrustations here are hard, see, that is, it’s hard, this seems to be as if it had been done… That’s why it’s called calcifications, like dried lime , but we had never had a calcified language, now we show it to you in the CT scan.

Look, we’re going to finish, this is the last fibroid, we left it because it was the most difficult, this part here is the endometrial sac, that is, here is the endometrium, the cavity but I wanted to show you because this patient, when Before putting it in today, he went to the consultation because he brought his CT scan and the CT scan did not make it very clear to us if it was in the cavity or not. It’s not there, but that’s why it seems like it’s completely protruding into the cavity. Right now, it’s clear how it is in the menstrual cycle, because there is a little bleeding, but what we are going to do is resect it, try to leave at least a little fibroid but preserve the most important thing, well, its endometrial cavity bag, which is this part of here.

Ready, we’re done, look here are two of the largest fibroids. This is the fibroid that was intracavitary, well, close to the cavity. This is the other fibroid that was bilobed on the posterior surface and these are the ones that were anterior, and the calcified one. See the difference between this calcified fibroid, which in fact now is almost a stone! Compared to these, look, does it come out? and the incision was really very nice so we were done.

It even looks white with some as if it were lime outside and then well defined, round, but it is very important because this little patient had all the issues for which patients come to us at Creafam: Infertility, that is, her problem is that she wants to get pregnant and has never been pregnant, intermenstrual bleeding, heavy menstrual bleeding and also multiple myomatosis but this fibroid is punctual or specifically calcified. We wanted to show it to you in surgery and for you to see the difference sometimes with previous surgeries and the images are going to help us. allowing the fibroid to be seen perfectly well compared to the others, which are a calcified fibroid. So always remember: Knowledge is power, the patient is increasingly coming to us, you can call us, you can do virtual consultations, I just saw a patient who also comes from Chiapas thanks to these videos, with a tumor close to four kilos, four kilos and a half, which we will surely be showing them later, if she stays with us and another patient is in Ecuador, who just wrote to me.

So what is the advantage now with this new post-COVID dynamics or in the pandemic stage? The thing is that we can do a first virtual consultation via Skype, we talk, we do the direct or directed interrogation, they even send me either through the same conversation or later to my email the images, generally I request a tomography to be more sure and they only need that consultation, schedule the appointment for the final review and schedule surgery.

So, the important thing about this is that fibroids remember they can be single fibroids, multiple fibroids, giant fibroids, calcified fibroids, degenerated, cystic, solid but almost all of them generally have an implication of assisted reproduction, but the main thing is from the point of view of gynecological women’s health, generally they are heavy bleeding, anemia, this patient had anemia and the larger the fibroid is, sometimes the surgery is a little more complicated, that is why we are uploading more and more videos so that the patient is informed, Come to us and the ideal is to try to operate on fibroids that are below 10 centimeters, but single giant fibroids are very laborious but are usually also less dangerous than a multiple fibroid. So, Creafam, you can call us, you can make a consultation and we will guide you with a second opinion or come in for surgery, we are with you.