ST. LOUIS — Coring is an excellent technique for facilitating vaginal hysterectomy in patients with large adenomyotic uteri, according to Dr. Carl W. Zimmerman.
Adenomyosis creates a very dense, unforgiving myometrium that is very symptomatic for the patient, and affected uteri can reach at least 20 weeks in size without a well-defined mass that can be enucleated, he said at the conference, which was sponsored by the Society of Pelvic Reconstructive Surgeons.
Debulking is a challenge in cases like this, but a coring technique that changes the shape of the uterus can ease removal.
An incision is made around the cervix, the paracolpium is divided, and the blood supply is divided, creating a bloodless organ, he said.
“What you do then is take a knife and make an encircling cut concentrically around the cervix and into the fundus of the uterus, but parallel to the long access of the uterus and endometrial cavity, going around and around and around,” explained Dr. Zimmerman, professor of obstetrics and gynecology at Vanderbilt University, Nashville, Tenn.
If you do this long enough, and make incisions parallel to the endometrial cavity and away from the serosal surface of the uterus, the globular structure is converted to a tubular structure that can be a foot long or longer, and which “literally comes down to meet you,” he said.
Dr. Zimmerman is a speaker/proctor for Cook Medical, is a proctor for Boston Scientific Corp. and Covidien, and receives royalties from Lumitex Inc. and Marina Medical Instruments Inc.