Apr 15, 2019 | 367 Views
Vasopressin administration can be an effective method of reducing blood loss during gynecological procedures. This video outlines the physiology of vasopressin and clinical scenarios in which its administration can help mitigate blood loss.
Apr 15, 2019 | 357 Views
This video reviews the surgical vascular anatomy and techniques for ligating the uterine arteries at their original, or the anterior division of the internal iliac arteries.
Apr 15, 2019 | 215 Views
This video highlights the use of the STRATAFIX Symmetric PDS Plus Knotless Tissue Control Device is used to reapproximate the myometrium following myomectomy.
Jul 5, 2019 | 346 Views
This video presents perioperative and intraoperative techniques to minimize bleeding at multiple myomectomy by laparotomy.
Jul 5, 2019 | 301 Views
This video outlines the approach to radiofrequency ablation of uterine fibroids through the Acessa Procedure
Jul 12, 2019 | 341 Views
This video demonstrates a novel in which a tourniquet is applied during laparoscopic myomectomy to achieve hemostasis.
Sep 26, 2019 | 356 Views
The purpose of this video is to demonstrate surgical management of a large symptomatic fibroid in the 2nd trimester of pregnancy. This patient is a 26 year old G1P0 who presented to a tertiary care centre at 18 weeks and 3 days gestational age with severe abdominal pain, not controlled with intravenous and oral narcotics. She was otherwise healthy and incidentally was diagnosed with a fibroid during her dating ultrasound. An MRI of her abdomen and pelvis delineated this to be a pedunculated fundal uterine fibroid, measuring 19.4 by 13.2 by 16.2cm, retroplacental in location. Ultimately, she was consented for a laparoscopic myomectomy, with mini-laparotomy and morcellation. Post-operatively, this patient’s pregnancy progressed well and was uncomplicated. She underwent an uncomplicated spontaneous vaginal delivery at 40 weeks gestational age.
Sep 26, 2019 | 316 Views
Deep subendometrial fibroids represent a technical challenge for complete hysteroscopic removal. Such fibroids include deep type II submucosal fibroids, type III fibroids (intramyometrial abutting the endometrium), and hybrid stage II-V fibroids (intramyometrial extending in both directions, submucosa and subserosa) according to FIGO classification.This video demonstrates a case of a 34 year old female who had failed several embryo transfers with good quality blastocysts. After comprehensive testing for her recurrent implantation failure, the sole finding was a 2.3cm posterior wall, upper cavity, sub-endometrial fibroid 3mm from the serosa.The video presented captures the hysteroscopic removal of this 2.3cm intramural posterior wall fibroid in the upper cavity abutting and subtly elevating the posterior endometrium. The clip demonstrates the complete and safe removal of this technically challenging myoma, while offering some surgical tips. Following her myomectomy, the patient conceived after a subsequent embryo transfer and had a full-term caesarean delivery.
Sep 26, 2019 | 447 Views
The objective of this video is to review a technique for the hysteroscopic resection of Type 2 uterine fibroids. This is an educational video review featuring a case patient. Visual identification of fibroid type, surgical technique, and perioperative considerations are discussed. Gynecologists frequently perform hysteroscopic fibroid resections; however, Type 2 fibroids present a unique challenge where long operative time, excessive blood loss and fluid absorption, incomplete resection, and uterine perforation are important considerations. Our case patient is a 35 year old G1P0A1 woman with a history of secondary infertility, dysmenorrhea and heavy menstrual bleeding. Ultrasound demonstrated a 4.0 x 4.6 x 4.3cm Type 2 uterine fibroid, with a maximal distance of 7.8mm between the outer edge of the fibroid and the uterine serosa. The hysteroscopic management of Type 2 fibroids includes perioperative optimization, including preoperative planning and medical optimization. Ultrasound images should be reviewed prior to surgery, to determine the type of fibroid and the distance to the serosa. Visual identification of fibroid type at the time of hysteroscopy is also possible by observing the angle between the fibroid at its intersection with the endometrium. The techniques demonstrated in this educational video demonstrate visual identification and hysteroscopic resection of a Type 2 fibroid, including the creation of an endometrial flap overlying the defect after resection, to minimize postoperative intrauterine adhesions. In this case, resection is performed in the operating room using a monopolar resectoscope. Identification of fibroid type, including visual diagnosis, as well as attention to surgical technique and perioperative considerations, are essential for hysteroscopic resection of Type 2 uterine fibroids.
Sep 27, 2019 | 501 Views
In this video, we demonstrate three approaches to uterine artery occlusion at time of laparoscopic myomectomy as a blood-sparing intra-operative technique. A step-wise approach is applied prior to beginning the myomectomy which includes the following: 1) Selecting the appropriate approach to uterine artery occlusion (lateral vs. posterior vs. anterior) based on individual anatomy; 2) identification of relevant anatomy and important landmarks for the procedure 3) isolating the uterine artery and identifying the ureter; 4) occluding the uterine artery. As illustrated in this video, uterine artery occlusion can be performed by three different approaches, depending on both surgeon preference and unique patient anatomy. A systematic review and meta-analysis of the literature supports the efficacy of this procedure in terms of limiting blood loss, blood transfusion, and fibroid recurrence, albeit at slightly longer operative times.
Sep 27, 2019 | 289 Views
The objective of this video is to demonstrate a simple, temporary and reversible method for uterine artery occlusion at the time of laparoscopic myomectomy. A 42 yo G0 presented with a solitary, vascular uterine fibroid. her signs & symptoms were heavy menstrual bleeding, pressure symptoms and abdominal bloating.Because the patient desired fertility, laparoscopic myomectomy was done with intra-operative approaches to minimize blood loss; including reversible uterine artery occlusion using bulldog clamps, vasopressin, tranexamic acid and misoprostol.
Sep 24, 2020 | 241 Views
In this video, we present an approach to previously described suprapubic laparoscopic-assisted myomectomy that we feel mitigates some of the disadvantages of traditional myomectomy - increased operative time, increased blood loss and surgical expertise in laparoscopic suturing. Using footage from our own procedures of this kind, we propose a method by which a fibroid is just partially dissected free of the myometrium, is tagged with a unique suture and morcellated while still within the myometrium.
Sep 24, 2020 | 120 Views
Cervical myomectomy is a surgical challenge and the risk of subsequent cervical incompetence is unknown. We presented the case of a 30-year-old woman, nulligravida, with a 12 cm cervical leiomyoma, who consulted for heavy menstrual bleeding and pelvic pain. After failure of multiple medical therapies, a laparoscopic cervical myomectomy was successfully performed. Adjuvant pre-operative uterine artery embolization with gelatin sponges was used to reduce surgical blood loss, as an alternative to intra-operative ligation of uterine arteries when access to the retroperitoneum is limited by the size and location of leiomyomas. In order to prevent cervical incompetence, a concomitant laparoscopic cerclage was achieved since the integrity of the cervix has been compromised by the myomectomy.