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| Name | MYOMECTOMY with a degenerative changes in a routine traditional surgery |
| Video Uploader | Video From Dr Some Gowda, MD, Obstetrics and Gynecology |
| Upload Date | This Video Uploaded At 20-10-2024 08:37:01 |
| Video Discription | Over coming the difficulties during the MYOMECTOMY with a degenerative-changes in a routine traditional surgery. Pseudocapsule of the fibroid can be easily delineated in cases of solid fibroids with myohyperplasia rather than less myohyperplasia and with cystic degenerative changes and Adenomyosis and also in infective and sarcomatous-changes. Generally because of the hyper oestrogenic state may be associated with the fibroids ,adrnomyosis, myohyperplasia,endometrial hyperplasia typical- atypical , cystogladular hyperplasia, polyp, ca in situ ,functional follicular cysts, PCOS external endometriosis and fibroadenoma of the breast in total about 5 to 10% of the cases Routinely one should know prerequisite of myomectomy. To avoid injury to the endometrium in case of big fibroid with the degenerative and infective changes one has to take some precautions to avoid the injury to the endometrium 1) Transcervical Foleys catheterisation with inflating the buld with 6-7 ml of water and instilling few ml of methylene blue may also help in identifying the endometrial damage 2) During LAPROTOMY one can open the uterine cavity at the fundus instilled the methylene blue and pass a Foleys catheter 3)Open up the uterine cavity one can introduce ones finger into the cavity and it will help to delineate the demarcation of capsule and desect without damaging the endometrium. Finally one can close routinely as in Stassman’s operation Whatever said and done in case of a big cystic degenerative and past previously infected fibroid in post menstrual stage where the endometrium is thin ,even imagined planed extra cautiously to avoid injury to the endometrium inspite that one may damage the endometrium in such situations dissection with the finger in the cavity may be helpful . Good expert patience ANAESTHESIOLOGIST at the Head end is of the real value otherwise many a times one may land up in Hysterectomy. Once happened to me finally landed up in a case of unmarried, nulliparous lady aged 27 yrs with multiple fibroids with heavy menstrual bleeding with severe dysmenorrhea,Rh negative landed in HYSTERECTOMY. Pt aged 36 yrs with primary infertility of 32wks size cystic degenerated fibroid was admitted for myomectomy laparotomy was done with vertical incision extending above the umbellicus uterus was delivered by tilting it. Lap findings the uterus was globellur uniformly enlarged and cystic difficult to identify its position, on the top both the tubes were stretched and normal. Both ovaries were of adequate volume with the evidence of previous ovulation. Probably posterior cystic mass encircling the endometrial cavity like HORSE SHOES fashion with minimal myohyperplasia. Sharp dissection was needed with the scissors to separate from the myometrium. The bed of the myoma after its eneucleation. Try to test the tubal patency from medial end . Finally closing endometrium.It was difficult to identify the endometrial lining Lower part of the cavity was identified by passing artery forces through the cervical canal It was v difficult to suture the endometrial layer .To make it easy the uterus was split into two halves first endometrial layer closed from below up wards, posterioly and anteriorly then the myometrium In two layers after excision of the part of the hyper plastic myometrium. Eneucleated specimen of the cystic degenerated fibromyoma it was feeling like a water ball . During euneaucliation of the myoma I would have sliced the myoma to avoid injury to the endometrium but it is difficult to judge the sarcomatous changes. Finally at least three cycle follow is needed to judge regarding the menstruation, dysmenorrhea, localised haematoma, haemtometra and the adenomyosis as delayed complication . Sometimes one can advise HSG during follow up to know the regularity and the capacity of the endometrial cavity. She was councilled and taken concent for the above and also for the hysterectomy if needed at time of discharge.If everything goes alright she can try for the conception. |
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