Laparoscopic Myomectomy for Pedunculated Myoma A minimally invasive procedure with maximum benefits

Aaradhya Sharma

https://www.laparoscopyhospital.com/SERV01.HTM  This video demonstrates Laparoscopic Myomectomy for Pedunculated Myoma by Dr. R K Mishra at World Laparoscopy Hospital. Laparoscopic Myomectomy for Pedunculated Myoma is a minimally invasive surgical procedure used to remove pedunculated uterine fibroids. This procedure offers maximum benefits with minimal invasiveness. Instead of a large incision in the abdomen, the surgeon makes small incisions and inserts a laparoscope, which is a thin tube with a camera and light attached to it. The laparoscope allows the surgeon to see inside the abdomen and locate the pedunculated myoma.  The surgeon then uses specialized surgical instruments to remove the fibroid, which is located on a stalk or peduncle. This method is less invasive and has fewer risks compared to traditional open surgery. It also offers a faster recovery time and a lower risk of complications.  Laparoscopic Myomectomy for Pedunculated Myoma can provide relief from symptoms such as heavy bleeding, pelvic pain, and discomfort. This procedure also preserves the uterus, making it an ideal option for women who want to maintain their fertility.  Overall, Laparoscopic Myomectomy for Pedunculated Myoma is a safe and effective procedure with maximum benefits. It allows women to return to their normal activities quickly while also providing relief from painful and uncomfortable symptoms caused by uterine fibroids.  World Laparoscopy Hospital Cyber City, Gurugram, NCR Delhi  INDIA : +919811416838  World Laparoscopy Training Institute Bld.No: 27, DHCC, Dubai  UAE : +971525857874  World Laparoscopy Training Institute 8320 Inv Dr, Tallahassee, Florida  USA : +1 321 250 7653

Transcript

00:00Hello friends, this is a case of laparoscopic myomectomy. This patient has one large 25 cm

00:08myoma and we can see approximately 2 kg of the myoma came out after morcellation. So this is

00:15the after surgery we have morcellated. But this was a simple case. Do you know why? Because it

00:21was a pedunculated myoma. This is little adhesion due to the previous surgery. This is baseball

00:27diamond concept and we will put one port palmers and other port lumber. So this is the first adhesion

00:34is removed. This adhesion was due to the previous surgery and this adhesion is removed by simple

00:43harmonic. And after that this is the myoma which is very big reaching up to falciform ligament which

01:00you can see. This is upper abdomen. It is almost pushing the gall and liver in the upper abdomen.

01:07Now going back down there in the uterus,

01:10the good thing about that in spite of being the large size it was sub-serious.

01:15Most of the large myoma become sub-serious because they split the muscle

01:20and they come out. And we can see here this is 2 ipsilateral port and we can see this is uterus

01:26and it is pedunculated. This is the myoma. So we are using the extra-corporeal knot

01:31and going as near as possible to the uterus and taking the suture out.

01:35So here again we will use the mishra's knot that is very good knot and it is

01:43very strong knot up to you know 18 to 22 millimeter structure. It can secure the vessel very nicely.

01:50So feeding the suture four times and now taking the suture out.

01:59After that you will tie the knot and this is first hitch

02:03then first wind, then first lock, then second wind, second lock and finally third wind and final lock.

02:18Then you will push it by the knot pusher and nearer to the uterus, as nearer as possible,

02:28you can tie the knot. You should not leave any part of the myoma and tie on the uterus

02:34near the shirosa. So that recurrence will not happen.

02:37Then you can tie as much as possible, as big as possible and keep the suture big

02:45because that suture will act as a retractor and you can wrap it around the grasper

02:50so that it will not slip and it will act as your retractor.

02:54And beauty of the knot, this knot is as much as you will pull, it will become more tighter

03:00because it is a slip knot. One of the limb of this knot which is used for the straight limb,

03:05if you will pull it, this knot will become more tighter. Other knot such as knot or another knot,

03:11if you will pull the knot, it will become loose but here it is reverse.

03:15So now this is ligature, it is coagulating

03:21distal to the knot and then you can cut and you can remove the pedunculated myoma.

03:28You can see that there is no bleeding, little bleeding which is happening that is also through the

03:32uterus side, not through the myoma side, not through the uterus side. Uterus side is dry.

03:51Now we will remove the second myoma, this myoma is also sub-serious and this is the myoma screw

04:08fixing on the second myoma and cranial traction is given and this myoma also will be removed.

04:14So you can see in spite of the big size, these are the easy surgery. So myoma location is more important

04:23than the size and the number.

04:44So this myoma is also completely sub-serious which doesn't create any weakness of the muscle

05:01and this was a small.

05:07After that we will do the suturing. Although this myoma is also sub-serious, even if you will

05:12cover with the entire seed it will work. But this one we are planning to suture. Although it is dry,

05:19there is no bleeding. So here this is the suture. And this is the suturing of this myoma is going out.

05:30Only single layer, only shirosa because there is no muscle defect in this.

05:37And here we are using baseball suture. In baseball suture always you will go in to out.

05:46Although the first time suture has to taken from out to in but after that always in to out.

05:52And you can reverse the needle and then you can take the bite from in to out.

06:00Again you can rotate the needle after pulling it. And one of the advantages of baseball suture is

06:19that margin will get little inverted so that the adhesion will be less. Although anyway in this one

06:25we are going to cover the entire area by interseed so it is tightened and then further suturing will carry out

06:44from in to out from in to out.

06:56The suture itself will be used as a retraction.

07:00The suture itself will be used as a retraction.

07:04The suture itself will be used as a retraction.

07:17The suture itself will be used as a retraction.

07:23The suture itself will be used as a retraction.

07:44Here we are holding ovarian ligament.

07:46The suture should not be held because it can create a stricture.

08:06And this is the final knot is done.

08:11After that you can pull and the margin will get inverted.

08:14Then we will return back to reach to the tail which will be used for termination.

08:44Coming out again to the healthy shirosa.

09:09Coming out again to the healthy shirosa.

09:14Coming out again to the healthy shirosa.

09:32This is your suture.

09:40And this is surgeon's knot.

09:42First time double wrap.

09:44Followed by two opposite alternating wraps.

10:17After that suture will be cut out and then now the suture will be cut out and then it

10:40can be easily removed with the 5 mm put.

10:48After that here we are using interseed and this will cover the entire uterus, fundus as

10:58well as posterior wall.

11:03So this is spreading over.

11:04Take care that you should spread it once it is dry.

11:11Because once it is thick then it will be very difficult to separate it.

11:15It will start breaking like a wet tissue paper.

11:21So you will cover the entire stump of the knot and posterior wall.

11:25There is little fluid you can see in the posterior wall.

11:29That is the only blood loss which happened in this surgery.

11:34So you can take one suction and you can suck those fluid out and then you drop the uterus.

11:45An interseed will prevent the adhesion from the surrounding organ and it get absorbed itself.

11:52So there is no issue.

11:56And after that you can spread it.

12:00And then morselation will be carried out.

12:02You may put few drops of saline also over the interseed.

12:06So that it will stick nicely.

12:11So now we will start the morselation.

12:14You can see this is large fibroid up to reaching up to falci from ligament.

12:19So it will take little time to morselate.

12:23This is a storage morselator.

12:25That much big fibroid anyway you cannot morselate inside the endobag.

12:32So you have to be careful that malignancy should be ruled out.

12:38And then slowly we can see it is morselating.

12:47So entire process of morselation we will not show you because it will take at least half

12:52an hour time we will take to morselate.

12:55Maybe more than that.

12:56So it is a long process sometime more time than the surgery.

13:03So this is the morselation which will be carried out.

13:07So thank you very much for watching this video.

13:10This was just a simple case of sub-serious pedunculated laparoscopic myomectomy which

13:17was removed by the misrage knot and covered by the interseed.

13:22Thank you very much have a nice day.

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