“LAPAROSCOPIC MYOMECTOMY: TIPS FOR PATIENT SELECTION AND TECHNIQUE”
WILLIAM H. PARKER, MD (JULY 2017)
Approach for removing cervical fibroids
I thank Dr. Parker for his tips on laparoscopic myomectomy. I have one question: Should large cervical fibroids be tackled laparoscopically? If yes, then please provide some tips. Cervical fibroids are sometimes difficult to enucleate, and nothing can catch the fibroid, as the consistency is such that everything cuts through.
Manju Hotchandani, MD
New Delhi, India
Dr. Parker responds
Magnetic resonance imaging is the best imaging approach for helping to evaluate the position and size of a cervical fibroid. Fibroids that are intracervical are best removed through a vaginal approach. With the patient under adequate anesthesia, the cervix is dilated or, if necessary, incised (Dührssen incisions), and the fibroid grasped with a tenaculum. The fibroid is finger dissected away from the cervix until the pedicle is palpated. The pedicle is either clamped or ligated with suture and then cut, and the cervix is repaired.
If the fibroid is intramural/subserosal and coming off the lower uterine segment or cervix, we identify the ipsilateral ureter and follow its course near the fibroid. An incision is made over the fibroid and directed away from the ureter. It is important to incise down through the fibroid pseudocapsule and to dissect the fibroid underneath the pseudocapsule, decreasing the risk of injury to the ureter and uterine vessels. Depending on the size and position of the fibroid and the experience of the surgeon, this technique can be performed laparoscopically.
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