Hellow guys, Welcome to my website, and you are watching Intraoperative Strategies to Minimize Blood Loss During Myomectomy. and this vIdeo is uploaded by CanSAGE Secretariat at 2024-02-07T09:54:17-08:00. We are pramote this video only for entertainment and educational perpose only. So, I hop you like our website.
| Name | Intraoperative Strategies to Minimize Blood Loss During Myomectomy |
| Video Uploader | Video From CanSAGE Secretariat |
| Upload Date | This Video Uploaded At 07-02-2024 17:54:17 |
| Video Discription | Presented By Dr. Alysha Nensi Dr. Deborah Robertson Affiliations University of Toronto See full transcript here: www.cansagevideos.com/intraoperative-strategies-to-minimize-blood-loss-during-myomectomy/ The objective of this video is to demonstrate various evidence-based strategies aimed at minimising surgical bleeding during open, robotic and laparoscopic myomectomy. Fibroids are common benign masses which can result in significant morbidity for affected women due to heavy menstrual bleeding and anaemia, bulk symptoms and infertility. In women who are premenopausal or wishing to retain future fertility, the surgical management of symptomatic fibroids is by way of myomectomy. Myomectomy can result in a significant degree of blood loss and intraoperative transfusion rates can be as high as 20%. Major surgical bleeding and intraoperative transfusion are correlated with increased short-term morbidity and mortality, as well as other long-term complications such as transmission of infection and alloimmune sensitisation. Gynaecological surgeons have utilised a number of interventions in an attempt to reduce rates of surgical bleeding during myomectomy. A recent Cochrane review groups these interventions into four main categories. Temporary or permanent occlusion of uterine arteries, uterotonic medications, myoma dissection techniques and chemical manipulation of the coagulation cascade. While a number of interventions are discussed and reviewed in the literature, clinical practice varies considerably between surgeons. A recent Delphi study presented by Bao et al in 2018 presents a standardized approach to decreasing blood loss during myomectomy. This clinical practice bundle is an expert consensus designed by a multidisciplinary team and takes into account evidence and guidelines from multiple specialties. This video will highlight the various elements of this clinical bundle which can be used to minimize intraoperative blood loss during abdominal laparoscopic or robotic myomectomy. Tranexamic acid is an antifibrinolytic agent which can be administered at a dose of one gram intravenously prior to the start of the case. While the data supporting the use of tranexamic acid during myomectomy is still limited, its low cost, wide availability, favourable side effect profile and strong evidence for effectiveness in orthopaedic surgery, cardiac surgery and postpartum haemorrhage, support its use during myomectomy. Misoprostal is a uterotonic agent which has also been shown to reduce blood loss and transfusion rates during myomectomy. It can be administered vaginally or rectally at a dose of 600 micrograms prior to the start of the case. Intramyometrial vasopressin has been shown to reduce blood loss and transfusion rates during myomectomy when compared to placebo. The maximum safe dose of vasopressin has not been established, but the literature describes diluting 20 to 40 international units in 100 to 200 millilitres of normal saline. Anaesthesia should be informed prior to injection of vasopressin and care should be taken to avoid intravascular injection as there have been rare cases reported of bradycardia and cardiovascular collapse. Blanching of the myometrium and fibroid capsule can be seen after injection. In the case of robotic or laparoscopic myomectomy, a spinal needle can be passed directly through the anterior abdominal wall, as demonstrated here, and vasopressin can be injected directly into the fibroid. With the assistance of the laparoscopic or robotic instruments, vasopressin is injected in various spots along the proposed incision route. Once again, blanching of the myometrium is seen with injection of vasopressin. And due to this intervention, bleeding is minimal once the uterine incision is made. For large intramural fibroids, a paracervical tourniquet can be used to temporarily occlude the uterine blood supply. The broad ligament is palpated at the level of the internal cervical os, and a clear space is identified, free of vessels or the ureter. A one-centimetre incision is made, and the tourniquet is passed through the incision. In this example, a red rubber catheter is used as a tourniquet. Depending on the resources available, various other items can be used, including a Foley catheter or a flexible Penrose drain. After repeating the appropriate landmarking, an identical incision is made in the broad ligament on the contralateral side and the tourniquet is passed through the hole with the assistance of a curved clamp. The tourniquet can be secured on the anterior or posterior surface of the uterus. In this example, it will be secured on the posterior side, and so the tourniquet is placed just above the level of the internal cervical os anteriorly. |
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