8901 Strategies for a Successful Minilaparotomy Myomectomy

Abstract

<h3>Study Objective</h3> To provide a unique video highlighting techniques to promote a successful minilaparotomy myomectomy of large uterine fibroids. <h3>Design</h3> Video presentation. <h3>Setting</h3> Academic tertiary care hospital. <h3>Patients or Participants</h3> A nulliparous 37-year-old presented for fertility sparing surgical management of symptomatic uterine fibroids via a minilaparotomy incision. Pre-operative planning included a pelvic MRI notable for two large FIGO 7 fibroids, one of which was an 11 cm pedunculated myoma that was noted to have torsed along with the fallopian tube. <h3>Interventions</h3> This video highlights techniques of mitigating blood loss including the pre-operative tranexamic acid and rectal misoprostol. Moreover, a handheld vessel sealer was specifically chosen for this procedure to ensure efficiency of dissection and hemostasis. Unique to our video is the use of a tourniquet to mitigate bleeding from a large myoma stalk. Additionally, a cell-saver was utilized to minimize the risk of a blood transfusion. In order to promote visualization and uterine mobility, a self-containing circumferential retractor was utilized, and the patient was placed in dorsal lithotomy with a uterine manipulator. Highlighted in this video is the importance of the core/wedge technique, which facilitated the decompression and evacuation of 689g of fibroids from a 6 cm minilaparotomy incision. <h3>Measurements and Main Results</h3> Our hemostatic efforts were successful in minimizing blood loss, which was estimated to be 350cc, below the threshold for cell saver autologous transfusion. The entire procedure was successfully performed with a minilaparotomy incision, and the patient met criteria for same day discharge. <h3>Conclusion</h3> Strategies for a successful myomectomy include the use of pre-procedure tranexamic acid and misoprostol, cell saver for possible autologous transfusion, a self-containing retractor, handheld vessel sealer/tourniquet, and efficiency with the core/wedge morcellation technique.