The steps of myomectomy

Myomectomy is also a treatment for cervical uterine fibroids or overly large fibroids, but many people don’t know much about this treatment method, so the following are the specific steps of myomectomy and scientific selection of treatment methods.

1. Incisions: midline incision in the lower abdomen or transverse incision above the pubic symphysis.

2. Explore and understand the location, size, and number of uterine fibroids to determine the uterine incision.

3. Blocking the blood supply to the uterus Before removing the uterine body myoma, make a small incision in the avascular area of ​​the left and right broad ligaments of the isthmus of the uterus, insert a rubber tourniquet through it, tie up the uterine artery and vein, and temporarily block its blood supply. If the operation time is long, loosen the tourniquet for 1 minute every 10 to 15 minutes. Uterine contractions can also be injected into the myometrium during surgery to reduce bleeding.

4. Removal of intramural fibroids: In the area with fewer blood vessels on the surface of the fibroid, a longitudinal, fusiform or arcuate incision is made depending on the size of the fibroid, deep into the fibroid capsule, and blunt separation is performed along the surface of the capsule. When there are more blood vessels at the base, the tumor can be clamped and cut out, and the residual end can be sutured. Use absorbable sutures to make an "8" shape or continuously suture 1 to 2 layers of the muscle layer. Be careful to avoid dead space when suturing. The seromuscular layer is sutured intermittently or continuously with No. 0 absorbable sutures. For multiple myomas, multiple myomas should be removed from one incision whenever possible. For fibroids close to the uterine cornu, the incision should be made as far away from the uterine cornu as possible to prevent postoperative scars from affecting the patency of the fallopian tubes.

5. Resection of subserosal myomas: This type of myoma often has a pedicle, and the pedicle can be clamped close to the uterine wall to remove the myoma. When the tumor pedicle is wide, a fusiform incision can be made at the base to remove the superficial muscle layer of the fibroid and uterine tumor pedicle.

6. Submucosal myoma resection: If the myoma obviously protrudes into the uterine cavity, it is necessary to enter the uterine cavity to remove the tumor. When suturing the myometrium, the mucosal layer should be avoided to prevent the endometrium from implanting into the myometrium and artificially causing endometriosis. For pedunculated submucosal fibroids, they can be removed through the vagina.

7. When removing cervical fibroids, one should understand the relationship between the fibroids and the bladder, rectum and ureter. For cervical anterior wall myoma, first open the bladder reflected peritoneum, sharply separate the bladder to the lower and lateral edges of the myoma, cut the anterior cervical wall tissue to the tumor surface, bluntly separate along the tumor capsule to the base, clamp and remove the myoma, and suture the residual end. The cervical muscle layer is sutured in 1 to 2 layers with absorbable sutures in an "8" shape or continuous mattress style, and the bladder peritoneum is sutured.