Special Surgical Procedures II
LESSON 2: Procedures in Gynecological and Obstetrical Surgery
2-38
2-38. ABDOMINAL MYOMECTOMY
a. General. This operation involves the removal of fibromyomas from the uterine wall through an abdominal incision. It is usually done in young women with symptoms that indicate the presence of tumors and who have had no children. The tumors may be removed because of infertility or habitual abortion or because of distortion of the bladder and other organs. Myomectomy may be performed in conjunction with other abdominal pelvic surgery as a prophylactic measure.
b. Operative Procedure.
(1) The patient is prepared as for abdominal hysterectomy. A midline or Pfannenstiel incision is used and the uterus exposed.
(2) To contract the musculature of the uterine wall, a suitable drug may be injected into the fundus. If the tumor is riding over the bladder or to free the ligament from the tumor, the round ligament may be doubly clamped, cut, and ligated, as in hysterectomy. The broad ligament may be opened to determine the course of the ureter or to free the bladder by means of curved hemostats and Metzenbaum scissors.
(3) An incision is made in the uterine wall down to the fibroid tumor which is grasped with a tenaculum.
(4) Each tumor is shelled out of its bed, using blunt and sharp instruments. Bleeding vessels are controlled by deep interrupted sutures number 2-0 chromic gut.
(5) The uterus is reconstructed with interrupted chromic gut number 2-0 sutures swaged to 3/8- circle trocar-point needles held on long needle holders.
(6) The round ligament is reapproximated by several interrupted sutures, and the anterior sheath of the broad ligament is closed. The perimetrium is closed over the operative site. The abdominal wound is closed.
