Video Description
This video highlights the use of the STRATAFIX Symmetric PDS Plus Knotless Tissue Control Device is used to reapproximate the myometrium following myomectomy.
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Affiliations
University of Calgary
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Video Transcript: STRATAFIX Symmetric PDS Plus Knotless Tissue Control Device: Myomectomy
This patient has been suffering from abnormal uterine bleeding and subfertility as a result of this large type III myoma. In order to minimize intraoperative blood loss and maximize visualization, the uterine myometrium has been infiltrated with a dilute vasopressin solution.
Additionally, a paracervical tourniquet with a Penrose drain secures the uterine blood supply. And finally, the use of the HARMONIC scalpel, HD 1000i, allows for excellent tissue dissection with minimal bleeding. Following the myomectomy, there is a large myometrial defect in which the anterior fundal portion of the endometrial cavity can be seen.
We can now begin closure. The first step to this is anchoring the STRATAFIX Symmetric. To do this, a pass is taken with the needle, and the suture is pulled through to the tab at the end. A second pass is then taken at a right angle to the first. This ensures that the suture is anchored.
Once the STRATAFIX Symmetric has been properly anchored, the myometrium can be closed in several layers using continuous, non-locking throws. The STRATAFIX Symmetric’s design makes it ideal for myometrial closure given its greater holding strength compared to V-Loc 180 or interrupted Vicryl.
The STRATAFIX Symmetric is available in a number of lengths, as much as 24 inches or 60 cm. However, should the need arise to employ a second suture, then we simply go through the anchoring step one more time. The suture is passed through the tissue, and the suture is pulled through to its tab and passed through once again at a right angle to the original pass.
Finally, once the multi-layer closure of the myometrium is complete, we can move on to closing the serosa. A baseball-type closure is utilized in which the Apogee is secured with a deep to superficial throw. Alternating forehand and backhand throws from deep to superficial complete this task and bury the barbs.
As you can see, the final closure reapproximates the tissue well, there are no exposed barbs, and it’s hemostatic.