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Laparoscopic Management Of Broad Ligament Myoma

Didactics And Hands-on Hints
View in high definition Video requirements
Vaghasia Haresh,
Asian Heart & Superspecialty Hospital,
Mumbai

PERSONAL COMMENTS:
This is an interesting video with background voice over demonstrating the standardised technique for laparoscopic broad ligament myomectomy with selection all types of cases (with & without ureteric injury).

ABSTRACT:
Objective: To demonstrate the standardized technique of laparoscopic broad ligament myomectomy. Design: Few case reports in video format. Setting: Tertiary center for Gynaecological Endoscopic Surgery in India. Patients: From January 2002 to January 2006, 48 patients (age group 22-36) with moderate to large size symptomatic (true & false types) broad ligamentary myomas underwent laparoscopic myomectomy. Of these 48 cases, 42 cases had false broad ligament myomas & 6 cases were true broad ligament myomas. Technique: Recently there is an increasing trend for minimal access surgery for myomas. Main concerns are subsequent fertility, reproductive outcome and long-term recurrence. Recent evidence favors safety and reliability of laparoscopic myomectomy. Pre-operative GnRHa is associated with loss of cleavage planes due to hydropic degeneration. This may make dissection difficult & hence we did not use GnRHa. Injection Pitressin was not infilterated in any case. Standard approach is an oblique incision parallel to vascular structures. Ultrasonic scalpel works well for this as it controls the bleeding & also creates a demarcation of tissue plane by its unique cavitational effect. Ureters are main concern due to alterations in the normal course. Fiber-optic ureteric probe is an excellent tool for primary prevention of ureteric injury. Results: Employing this technique all 48cases were performed without major complications. However, 10% had minor complications like fever & blood transfusions. The average blood loss was 150mL with highest amount up to 450mL. The average hospital stay was 48/60hours. Conclusion: Broad ligamentary leiomyomas are the most difficult to tackle at laparoscopy. However, adherence to microsurgical principles & prevention of ureteric injury makes them most rewarding. Laparoscopic myomectomy has provided minimal invasive alternative to laparotomy for several reasons including faster recovery and reduced blood loss & adhesions. In a way, it is far superior to the open procedure.
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