How safe is Laparoscopic Myomectomy? - Dr. Usha B. R скачать в хорошем качестве

How safe is Laparoscopic Myomectomy? - Dr. Usha B. R

Laparoscopy is the state of the art care for surgical management of fibroids these days. What we do for laparoscopy these days is we operate through small keyholes of 5 to 10 mm and we try to take out the fibroid within these small holes itself. So there are three important steps in laparoscopic myomectomy. We operate through 4 ports. The first step is where we make a small incision over the fibroid and we enucleate the fibroid, as in we try to take out the fibroid excluding the capsule. When we are doing that there is a lot of bleeding. So we try to reduce that by giving vasopresssin injection prior to the incision and then we try to take out teh entire fibroid in toto. The second step involved is suturing. Suturing requires a lot of skill with respect to the laparoscopic surgeon but in good hands it can be sutured very well in 2 to 3 layers using baseball suture and have good hemostasis and good approximation of the myometrium. This step is retrieval of the enucleated of fibroid. The fibroid is taken out for the uterus into the abdominal cavity and has to be take out through the small keyhole. So how do we do that ? We are dealing with keyholes of 10 to 15 mm. So w e put in the morcellator and we try to morcellate or make the fibroid into small pieces and we take out. So we usually do endobag morcelaltion when the fibroids are very big. Because of it is small fear of fibroids being cancerous and is there is a piece left behind there can be a dissemination or spread of cancer. However we are suspecting this we put an endobag inside and out small pieces inside the bag and we take out the small prices and tat the end of it w e take out the end of it. So the specimen is taken out without spilling anything into the abdominal cavity.