myomectomy.pptx

Myomectomy is a common operation but it is challenging

1. Dr.Rokeya Begum FCPS,MS 1. Graduated from Chittagong Medical College. 2.Working as Professor and advisor of Department of Obs & Gynae, USTC, Chittagong. 3. IVF specialist & Endoscopic Surgeon, Surgiscope Fertility & Endoscopic centre , Chittagong . 4. Special interest in High risk Obstetrics, Infertility & Endoscope. 5. Author of two books: - Clinical guide to Obstetrics and Gynaecology - Problem Based Questions Answer and OSCEs in Obstetrics and Gynaecology 6. Receive Life time achievement award in 2016 for Obstetrics and Gynaecology Society of Bangladesh.

2. Myomectomy is a common operation but it is challenging - Relieve of symptoms - Preservation of uterus - Fertility issue

3. What is the route Open Endoscope Hysteroscope Laparoscope Abdomen Uterus

4. FIGO classification of myoma Selection of case

5. Tools for myoma mapping 01 USG MRI 03 SIS 02 02

6. USG shows

7. Number Size Position Distances from the endometrial cavity Distance from serosa Number, size ,grade, location of myoma Detailed description of the myoma

8. Laparoscope / Hysteroscope

9. 0 and 1 submucous myoma suitable for hysteroscope. 2 and 3 difficult for hysteroscope. Hysteroscope

10. Good instrument Submucous myoma resection Instrument Scissors 1 2 Bipolar resectoscope 3 Mini resectoscope 4 5 Pressure bag/ Endomat pump Hysteroscopic morcellator

11. 6 Resectoscope - monopolar 8 7 Glycine as distension media Unipolar wire loop Good instrument

12. Tips Resection starts from base to tip Towards surgeon Always pulling Long strip of myoma has to resected Wire loop always visible Fluid balance monitoring

13. Complications Perforation Fluid overload Bleeding

14. Selection of patients - Large myoma upto Xiphysternum - Multiple –Suturing difficulty Laparoscope

15. Prevention of haemorrhage - Vasopressin injection - Ligation of uterine artery Laparoscope vasoconstriction Dilute vasopressin 20unit in 200ml N/Saline Avoid intravascular injection Cardiovascular complications

16. Incision over myoma - Horizontal - Vertical Laparoscope

17. Enucleation of myoma - Dissection - Traction and counter traction Laparoscope

18. Endometrial cavity open

19. Laparoscope Bipolar cautery for hemostasis of bed Check for missing myoma

20. Suture material V-Loc Stratafix knotless tissue control device

21. Suture/Reconstruction of myometrium

22. Laparoscope Suture/Reconstruction of myometrium

23. Laparoscope Morcellation/Delivery of myoma

24. 01 02 04 03 05 06 Knowledge of anatomy Knowledge of difficulties Knowledge of possible complications Knowledge of limits Knowledge of Technique Knowledge of instrument Tips

25. Concerns Technically feasibility Complication rates Conversions rates Long term failure

26. Adequate provision of structure training within the gynaecology residency programme . To equip new generation of gynaecologist with skills to perform these procedure. Prepare set benefits of minimal access surgery by avoid open surgery.

27. It is all about the Mind set and Training. To make possible Gynae endoscopic surgery “ By all for all ”