I have developed a new concept for removal of uterine leiomyomas. I call it 'Lateral Myomectomy'. Conventionally abdominal myomectomy is performed through preferably anterior uterine wall incisions, and when that is not possible through posterior uterine wall incisions. In both of these cases, the uterine scar is exposed to the intraperitoneal structures and adhesions with bowel and/or omentum are quite likely. This risk can be reduced using barriers to cover the suture lines until the serosa heals, like hydrofloataion or oxidized cellulose cover. The best way would be to avoid a serosal incision, which I achieve by opening the broad ligament and cutting the lateral uterine wall.
This technique is applicable when there is a large leiomyoma that expands the uterus globally i.e. in all directions. That expands the lateral uterine wall too. If it is an anterior wall leiomyoma, the round ligament and anterior leaf of broad ligament are cut. The uterine incision is made anterior to the ascending uterine vessels, above the uterine artery stem. If it a posterior wall leiomyoma, the posterior leaf of broad ligament is opened in front of the attachment of the utero-ovarian ligament, and the uterine incision is made posterior to the ascending uterine vessels. In both the cases, the uterine vessels are protected as the incisions runs parallel to them. The ureter is protected because it lies below the uterine artery stem, and downward extension of the incision is avoided by application of an Allis' forceps at that end. Fallopian tube is protected by applying an Allis' forceps at the upper end of the incision to avoid an extension of the incision during removal of the leiomyoma.. Tunneling incisions can be made as required through the bed of the leiomyoma removed, so as to remove any other leiomyomas present. Closure is by conventional technique. At the end of the operation the divided round ligament is reapproximated, and broad ligament is closed. There is no scar on the serosa of the uterus.
I have put a video of this on YouTube for those who want to see it. Do write to me if you have any questions.
YouTube Link: http://youtu.be/y1g5hPzHzw0
This technique is applicable when there is a large leiomyoma that expands the uterus globally i.e. in all directions. That expands the lateral uterine wall too. If it is an anterior wall leiomyoma, the round ligament and anterior leaf of broad ligament are cut. The uterine incision is made anterior to the ascending uterine vessels, above the uterine artery stem. If it a posterior wall leiomyoma, the posterior leaf of broad ligament is opened in front of the attachment of the utero-ovarian ligament, and the uterine incision is made posterior to the ascending uterine vessels. In both the cases, the uterine vessels are protected as the incisions runs parallel to them. The ureter is protected because it lies below the uterine artery stem, and downward extension of the incision is avoided by application of an Allis' forceps at that end. Fallopian tube is protected by applying an Allis' forceps at the upper end of the incision to avoid an extension of the incision during removal of the leiomyoma.. Tunneling incisions can be made as required through the bed of the leiomyoma removed, so as to remove any other leiomyomas present. Closure is by conventional technique. At the end of the operation the divided round ligament is reapproximated, and broad ligament is closed. There is no scar on the serosa of the uterus.
I have put a video of this on YouTube for those who want to see it. Do write to me if you have any questions.
YouTube Link: http://youtu.be/y1g5hPzHzw0
