Bonney was a genius. His hood operation is an evidence of his genius. It is the only operation available for a posterior wall leiomyoma of the uterine corpus, that leaves the scar on the anterior wall of the uteurus, protected from adhesions with bowel and omentum postoperatively.
It sometimes so happens that the transverse incision on the corpus for enucleation of such a leiomyoma is not wide enough to get the leiomyoma out. Enlarging the incision laterally is not an option, because the uterus is only so much wide. We had such a patient the other day. The incision was not long enough to permit removal of the leiomyoma and there was no place laterally to extend it.. Then I had an idea.
"Make an inverted T-shaped incision" I said.
The operating surgeon, my Registrar made a vertical incision in the midline, starting upwards from the original uterine incision.
"Now raise the two triangular flaps upwards and outwards" I said.
That was done, and the leiomyoma came out. The flaps were too big for reconstruction of the uterus and had to be trimmed. The part cut in the midline got excised and we had a single flap to cover the surface of the uterus. I have shown the steps diagrammatically below, because there was no one to take pictures. Perhaps we will do that the next time.
Flaps have been raised to expose the leiomyoma through an opening in serosa and pseudocapsule big enough to deliver the leiomyoma.
It sometimes so happens that the transverse incision on the corpus for enucleation of such a leiomyoma is not wide enough to get the leiomyoma out. Enlarging the incision laterally is not an option, because the uterus is only so much wide. We had such a patient the other day. The incision was not long enough to permit removal of the leiomyoma and there was no place laterally to extend it.. Then I had an idea.
"Make an inverted T-shaped incision" I said.
The operating surgeon, my Registrar made a vertical incision in the midline, starting upwards from the original uterine incision.
"Now raise the two triangular flaps upwards and outwards" I said.
That was done, and the leiomyoma came out. The flaps were too big for reconstruction of the uterus and had to be trimmed. The part cut in the midline got excised and we had a single flap to cover the surface of the uterus. I have shown the steps diagrammatically below, because there was no one to take pictures. Perhaps we will do that the next time.
Uterine incision
Vertical limb of the uterine incision
