IMAGING MODALITIES ULTRASOUND• Confirm Diagnosis• Size , Number• To detect small submucous fibroids• Detect distorsion of the cavity• Rule out ovarian tumour , adenomyosis• Ascitis?• Assess kidney and ureters..
MYOMECTOMY• Victor Bonney• Option for those who desire further child bearing or wish to preserve uterus• Women presenting with infertility and miscarriage – other causes should be ruled out.• Best for intramural and submucous fibroids
HYSTERECTOMY - AbdominalSteps1.Opening abdomen – Pfannensteil incision, uterus elevated with left hand , forceps placed on either side of cornua.2.First pedicle – round ligament [ 0/1 vicryl], if needed trace ureter. - if ovaries removed – infundibulopelvic lig. - if ovaries retained –tube & ovarian lig. cut
3. Bladder dissection – dissect bladder from anterior cervix, bladder pushed down4. Second pedicle - uterine vessels seletonised, clamped, cut and ligated. Clamp placed perpendicular to uterine artery at CU junction.5. Third pedicle - cardinal ligaments and uterosacrals clamped , cut ligated.6. Vaginal angles and vaginal edges- 2 clamps used to clamp across vagina.suture taken thru lt. vaginal clamps and uterosacrals.7. Closure of abdomen.
• Technique – Aim to occlude both uterine arteries to induce ischemic necrosis of fibroids – Done in the immediate postmenstrual period – Transfemoral approach on the right side – Embolisation using polyvinyl alcohol particles – B/l done – Discharge after 24-48 hrs – Follow up clinically and sonologically
Complications– Failure to cannulate– Local haematoma– s/v pain due to infarction– Menorrhagia decreases by 90% Postembolisation syndrome – fever, N,V– Infection reduction in fibroid volume by 50-70% &– Exposure to radiation– Persistent vaginal discharge– Pedunculated submucous fibroids expelled vaginally– Pedunculated subserous fibroids become infected– Non target organ embolisation