I had done a myomectomy by this technique long ago. It had been just 1.5 cm diameter leiomyoma that had arisen from the anterior lip of the cervix. It had no pedicle. I had cut its surface, enucleated it, and reconstructed the cervix. This time it was about 6 cm in diameter. It had arisen from the lower 1 cm of the anterior wall of the cervical canal. The cervix was 5-6 cm dilated, 50-60% effaced, and had only right, left and posterior lips. The anterior lip had been taken up by the leiomyoma. There was a broad base attached to the cervix, and no pedicle. Conventionally one would have cut it near the base and occluded the raw area with sutures. I decided to do otherwise. Normally one does not expect submucosal leiomyomas to have a pseudocapsule. I decided to see if that was true. So I cut its mucosal cover and underlying tissues with cutting electrocautery over 4-5 cm in midline. Then I dissected bluntly, and found that it did have a pseudocapule. I enucleated the entire leiomyoma from inside the pseudocapsule. The upper part of the cavity left behind was quite high. There was no active bleeding from it. I sprayed it with Feracrylum solution to ensure that any potential bleeder there would be stopped, placed a piece of oxidized cellulose in it as an additional safety measure, and then excised redundant part of the pseudocapsule and mucosa. Then I sutured the rest to the anterior wall of the cerical canal with polyglactin sutures, occluding the cavity in that process. The leiomyoma had expanded the cervical canal circumferentially, and the internal os was far away from the suture line.
The experience was very satisfying, and so was the result. I think this method is a better alternative to conventional method of treating such leiomyomas.
The experience was very satisfying, and so was the result. I think this method is a better alternative to conventional method of treating such leiomyomas.
