Distinct Strategy in Challenging Myomectomies: Associated Techniques with Two Stages Laparoscopy Surgery

Abstract

Study Objective To show an innovative therapeutic strategy with laparoscopy and associated hemostatic techniques aiming minimally invasive treatment in a challenging of giant uterus and multiple fibroids. Design Sequential demonstration of diagnosis, therapeutic planning, surgical approach and results with video surgery. Setting Myomectomy has been described as an alternative treatment of symptomatic uterus fibroids who desire fertility. The laparoscopy approach has relevant benefits like decreased blood loss, reduced length of hospital stays and quicker recovery1. However, in a big fibroid, specially 6 cm or more, the risk of bleeding increase2. In these cases, the use of associated techniques like clipping vessels and use of hemostatic solutions can be helpful, besides the imperative laparoscopic skills to achieve a good outcome. Patients or Participants A 27-year-old woman with symptomatic uterus fibroids refractory to medical therapy and with fertility desire. Interventions Diagnosis challenging uterus fibroids, the use of radiology exam, specially IRM and the sequential therapeutic planning with two stages laparoscopy surgery. The strategy in the first surgery stage included clamping the uterine artery at the origin and using hemostatic solutions: vasopressin and oxidized regenerated cellulose. The landmarks identification was the primary step to do these techniques and decides the incision local, and then the safely myomectomy was performed. The second stage of laparoscopic myomectomy was performed. Follow-up was performed with clinical evaluation and radiology exam. Measurements and Main Results Final pathology report showed leiomyoma with no evidence of malignancy. Patient had a great recovery after the surgeries, with no complications. An MRI was performed 3 months of postoperative with a significantly uterine volume reduction. Conclusion Big fibroids is a real challenging in women who wants a future fertility. A therapeutic arsenal that includes different hemostatic techniques must be used to achieve the goal of uterine preservation associated with minimally surgery benefits. Moreover, be familiar with all options and use them can provide a success outcome. To show an innovative therapeutic strategy with laparoscopy and associated hemostatic techniques aiming minimally invasive treatment in a challenging of giant uterus and multiple fibroids. Sequential demonstration of diagnosis, therapeutic planning, surgical approach and results with video surgery. Myomectomy has been described as an alternative treatment of symptomatic uterus fibroids who desire fertility. The laparoscopy approach has relevant benefits like decreased blood loss, reduced length of hospital stays and quicker recovery1. However, in a big fibroid, specially 6 cm or more, the risk of bleeding increase2. In these cases, the use of associated techniques like clipping vessels and use of hemostatic solutions can be helpful, besides the imperative laparoscopic skills to achieve a good outcome. A 27-year-old woman with symptomatic uterus fibroids refractory to medical therapy and with fertility desire. Diagnosis challenging uterus fibroids, the use of radiology exam, specially IRM and the sequential therapeutic planning with two stages laparoscopy surgery. The strategy in the first surgery stage included clamping the uterine artery at the origin and using hemostatic solutions: vasopressin and oxidized regenerated cellulose. The landmarks identification was the primary step to do these techniques and decides the incision local, and then the safely myomectomy was performed. The second stage of laparoscopic myomectomy was performed. Follow-up was performed with clinical evaluation and radiology exam. Final pathology report showed leiomyoma with no evidence of malignancy. Patient had a great recovery after the surgeries, with no complications. An MRI was performed 3 months of postoperative with a significantly uterine volume reduction. Big fibroids is a real challenging in women who wants a future fertility. A therapeutic arsenal that includes different hemostatic techniques must be used to achieve the goal of uterine preservation associated with minimally surgery benefits. Moreover, be familiar with all options and use them can provide a success outcome.