This is a experience of myomecties done by Dr.Ashok R. Anand at JJ hospital

1. MYOMECTOMIES- OUR
EXPERIENCE
Author- Dr. Ashok R. Anand
Presentor- Dr. Dimple Kriplani

2. We are going to share our experience of
myomectomies performed in our unit from
2010 to 2013.
In total, 36 myomectomies were performed
with a variety of coexisting conditions and at
different locations for different indications.

3. INDICATIONS
 To preserve reproductive function.
 For treatment of infertility.
 To preserve menstrual function and feminity.

4. MYOMECTOMIES PERFORMED FOR DIFFERENT
LOCATION OF FIBROID
 Uterine
 Broad ligament
 Cervical
 Vaginal
 Wandering

5. MYOMECTOMIES- SPECIAL CASES
 During Pregnancy
 During Cesarean Section
 During Vaginal hysterectomy
 During Abdominal hysterectomy

6. MATERIALS AND METHODS
 Patients were posted for surgery with
ultrasonographically confirmed diagnosis of
fibroid with appropriate indications for
myomectomy.
 Required preoperative and intraoperative
preparation was done.

7. PREOPERATIVE PREPARATION
 Majority of the Patients were given GnRH
analogue so as to reduce the blood supply
and shrink the size of myoma. 3.75 mg first
injection within first five days of cycle and 2
more repeated after 1 month each.
 Adequate blood was kept ready.
 Consent for sos hysterectomy was taken as
in any case of fibroid.

8. DURING SURGERY

9. A TOURNIQUET IS TIED AT THE LEVEL OF UTERINE
ARTERIES IN ORDER TO REDUCE THE BLOOD SUPPLY.

10. INFUNDIBULOPELVIC LIGAMENTS COMPRESSED WITH
SPONGE HOLDER.
INJECTION VASOPRESSIN IS INJECTED LOCALLY IN THE
CAPSULE OF THE MYOMA ALL OVER.

14. MYOMA BED AFTER MYOMECTOMY

16.  We try to avoid opening endometrial
cavity.
 If opened then sutured with polygalactin 3-
0 absorbable sutures.
 Myometrium is sutured with 2-0
absorbable polygalactin.
 Serosa is sutured with 3-0 absorbable
polygalactin with continous sutures.

17. SINGLE UTERINE FIBROID

20. MULTIPLE FIBROID MYOMECTOMY RANGING FORM 4 TO 40

27. CLOSURE OF UTERUS AFTER MYOMECTOMY

29. BROAD LIGAMENT FIBROID

31. BROAD LIGAMENT FIBROID AFTER MYOMECTOMY

32. CERVICAL FIBROID

33. CERVICAL FIBROID MYOMECTOMY

34. VAGINAL FIBROID MYOMECTOMY

37. WANDERING FIBROID

38. MEASURES TAKEN TO PREVENT POST OPERATIVE
ADHESIONS FORMATION
During Surgery-
 Absorbable haemostat material
(Surgicel)
 Inj. Hyaluronidase intraopeartive as
well as post operative period.
 Intercel.
 Inj Hydrocortisone.

39. SPECIAL CASES

40. MYOMECTOMY DURING PREGNANCY

43. CLOSURE OF PREGNANT UTERUS AFTER MYOMECTOMY

44. MYOMECTOMY DURING CESAREAN SECTION

45. MYOMECTOMY DURING VAGINAL HYSTERECTOMY

46. OUR EXPERIENCE (OBSERAVATIONS)
 Average blood loss – 100 to 150 cc
(Based on standardized visual method -fixed
container and mop)
 None of the patient required blood
transfusion.
 Febrile illness was found in 5 % cases.
 No other significant post op complication.

47. CONCLUSIONS
 By taking proper preoperative and
intraoperative measures, myomectomy can
be a safe procedure.
 Fear of blood loss and hysterectomy at the
time of surgery can be avoided.
 Fertility can be preserved irrespective of the
size, location and number.

48. THANK YOU