Fibroid Uterus: Surgical Challenges in Minimal Access Surgery

Cover
Half Title
Title Page
Copyright Page
Dedication
Table of Contents
Foreword
Preface
List of
Editors
List of
Contributors
Chapter 1: Counseling and Consent Challenges in a Woman with Fibroid Uterus
	Introduction
	Asymptomatic Fibroids and Not Planning Pregnancy
		Observation or Intervention?
	Asymptomatic Fibroids and Planning Pregnancy
	Pregnancy with Fibroids
	Women with Submucosal Fibroids
	Fibroids in Perimenopausal Age and Beyond
	Consent Before Myomectomy
	Consent Before Hysterectomy for Fibroid Uterus
	Laparoscopy/Laparotomy
	Risk of Sarcoma or Malignancy During Myomectomy/Hysterectomy
	References
Chapter 2: Preoperative Ultrasound Imaging in Fibroid Uterus
	Introduction
	Settings on the Machine
	Typical Features of Fibroids ON ULTRASOUND
	Classification of Fibroids
	Ultrasound Modalities to Map the Fibroids
		2D Transvaginal and Transabdominal Ultrasound
			3D Ultrasonography
			Role of MRI in Fibroid Mapping
		Other Methods of Mapping Fibroids
			Elastography
			Sonohysterography
	Steps for Fibroid Mapping
		Vaginal Entry
		Evaluating the Uterus
		Location of Each Fibroid in the Uterus
		Position of the Fibroid
	How to Measure Fibroids on Ultrasound Scan
		Echogenicity
		Relationship of the Fibroid to the Endometrium
		Endomyometrial Junction
		Vascularity of the Fibroids
	Reporting in a Case of Fibroid Uterus
	Conclusion
	References
Chapter 3: MRI before Myomectomy: How Can It Help You?
	Magnetic Resonance Imaging (MRI) Scanners and Hardware
	MRI Pulse Sequences
	Sequences in MRI
		Planes of Imaging
		Descriptive Terminology
	Appearance of Various Tissues in Different Sequences
	Diffusion-Weighted Imaging
	MRI Technique
		Patient Preparation
		MRI Protocol
			Planning for Axial and Coronal Sections for the Body and Cervix of the Uterus
	Normal Uterine Anatomy on MRI
	CBA
	MRI for Fibroids
		International Federation of Gynecology and Obstetrics Classification of Myomas
		Advantages of Using MRI
	Differentiating Fibroid from Adenomyosis
		Direct Signs of Adenomyosis on MRI
		Indirect Signs of Adenomyosis on MRI
		Diagnosing Leiomyosarcoma or Possible Sarcomatous Transformation of a Fibroid
		Differentiate a Subserosal Fibroid from an Ovarian Tumor
	References
Chapter 4: Fibroid and Infertility: When to Suggest Myomectomy?
	Introduction
	Etiopathogenesis
	Clinical Presentation
	Impact of Fibroids on Fertility
		Mechanisms of Infertility in Fibroids
			Physical Factors
			Effect on Uterine Peristalsis
			Molecular Impact
			Genetic Alterations
		Impact of Fibroids on Reproductive Outcome
			Submucosal Fibroids
			Intramural Fibroids
			Subserosal Fibroids
	Management of Women with Fibroids and Infertility
		Fibroid Evaluation
			Pelvic Examination
			Imaging of Fibroids
	Conclusion
	References
Chapter 5: Surgical Treatment of Fibroids
	Introduction
	Microscopic Facts and Fibroid Viability
	Costs of Fibroids
	Reasons for Hysterectomies in Patients with Fibroids
	Review of All Uterine-Preserving Treatment Possibilities for Fibroids
		Expectant Management
		Medical Therapy
		Alternative Treatment Methods
		Uterine-Preserving Surgical Treatment of Fibroids
		Counseling and Informed Consent
		Myomectomy
		Hysteroscopic Myomectomy
		Laparoscopic Myomectomy
		Abdominal Myomectomy
		Robotic Myomectomy
		Hysterectomy as Treatment for Myomas
	Should Ovaries or Fallopian Tubes (or Both) Be Removed or Left in Place at Hysterectomy?
		Ovaries
		Fallopian Tubes
	Conclusion
	References
Chapter 6: Reducing Intraoperative Blood Loss in Myomectomy: Better to Prepare and Prevent than Repair and Repent
	Introduction
	Classification System
	Approaches to Reduce Blood Loss
	Preoperative Approaches
		Gonadotropin-Releasing Hormone Analogues
		Ulipristal Acetate
	Intraoperative APPROACHES
		Misoprostol
		Oxytocin
		Vasopressin
		Bupivacaine and Epinephrine
		Antifibrinolytics
		Gelatin–Thrombin Matrix
		Intraoperative Uterine Artery Occlusion
	Hysteroscopic Myomectomy
	Laparoscopic Myomectomy
	References
Chapter 7: Hysteroscopic Myomectomy: Resection Techniques and Safety
	Surgical Techniques for Hysteroscopic Myomectomy
		Resectoscopy
		Morcellation or Tissue Removal System
		Enucleation
		Hysteroscopic Myolysis
	Myoma G0 (Sessile or Pedunculated)
	Myoma G1 or G2
		Resectoscopy with Monopolar Energy
		Resectoscopy with Bipolar Energy
		“Cold Loop”
		Vaporization
		Morcellator or TRS
		Laser
	References
Chapter 8: Laparoscopic-Assisted Myomectomy
	Introduction
		When to Choose a Patient for Laparoscopic-Assisted Myomectomy
	Laparoscopic-Assisted Myomectomy
		Our Technique
	Discussion
	Advantages of this Approach
	References
Chapter 9: Robot-Assisted Myomectomy
	Introduction
	Robot-Assisted Laparoscopic Myomectomy
	Key Surgical Steps
	Morcellation/Tissue Extraction
	Conclusion
	References
Chapter 10: Robotic Myomectomy: Tips and Tricks
	Patient and Trocar Positioning
	Surgical Technique
	References
Chapter 11: Cervical Fibroids: Techniques for Myomectomy and Hysterectomy
	Introduction
	Diagnosis
	Preoperative Preparations
	Surgical Approach
	Surgical Technique
		Removal of Myoma
		Defect Closure
		Prevention of Adhesion Formation
	Hysterectomy
		Anticipated Complications and Management
		Excessive Blood Loss
			Role of Vasopressin in Myomectomy
			Laparoscopic Uterine Artery Ligation
			Temporarily Blocking Methods
		Ureteric Injury
	Postoperative
	Points to Remember
	References
Chapter 12: Broad Ligament Fibroids: Techniques for Myomectomy and Hysterectomy
	Introduction
	Diagnosis
	Preoperative Preparations
	Surgical Approach
		Surgical Technique
			Backyard Theory
		Removal of Fibroids
		Anticipated Complications
			Concealed Hematoma Formation
			Ureteric Injury
			Role of Vasopressin in Myomectomy
	Postoperative
	Points to Remember
	References
Chapter 13: Breach of the Endometrial Cavity during Myomectomy and Its Implications for Subsequent Fertility
	Introduction
	Uterine Fibroid and Infertility
		Submucous Myoma
		Intramural Myoma
		Nonspecific Myoma
	Indications for Preconception Myomectomy
	How to Avoid A BREACH IN Endometrial Cavity?
	How to Repair an Endometrial Cavity
	The Complication of Breach of Endometrial Cavity during Myomectomy
		Intrauterine Adhesion and Infertility
	Conclusion
	References
Chapter 14: Predictors of Uterine Rupture and Recurrence after Myomectomy
	Introduction
	Uterine Rupture
		Obstetrical Aspects
		Surgical Aspects
	Recurrence
		Commonly Proposed Potential Risk Factors
		Other Factors to Be Considered
	Conclusion
	References
Chapter 15: Secondary Hemorrhage after Myomectomy
	Secondary Hemorrhage Following Myomectomy
	Management of Secondary Hemorrhage
	Conclusion
	References
Chapter 16: Laparoscopic Surgery for Fibroid Uterus: When to Convert to Laparotomy
	Introduction
		So How Do We Define Conversion from Laparoscopic Approach to Laparotomy?
	Why Worry about Conversion and When Is that Decision Made?
	Reasons for Conversion
	Conclusion
	References
Chapter 17: Cesarean Section in the Setting of Fibroid Uterus and Cesarean Myomectomy
	Introduction
	Epidemiology and Symptoms of Fibroids
	Treatment of Fibroids
	Myomectomy during Cesarean Section: A Historical Overview
	Cesarean Myomectomy
	Techniques of Cesarean Section with Myomectomy
	Risks of Cesarean Myomectomy
	Surgical Technique of Intracapsular Myomectomy during Cesarean Section
	Conclusion
	References
Chapter 18: Adenomyomectomy
	Indications
	Investigations
		Two-Dimensional Ultrasonography
		Magnetic Resonance Imaging
	Surgical Treatment for Adenomyosis
		Partial Reduction Surgeries
			Wedge Resection of the Uterine Wall
			Transverse H-Incision of the Uterine Wall
		Complete Adenomyosis Excision
			Triple-Flap Method
			Asymmetric Dissection Method
		Laparoscopic Approach to Adenomyosis
	Postoperative Pregnancy Outcomes
	Uterine Rupture Risk
	Factors Causing Uterine Ruptures
	Contraception Period BEFORE PLANNING Pregnancy AFTER ADENOMYOMECTOMY
	Laparotomy versus Laparoscopic Surgery
	Challenges Faced with Adenomyomectomy and Modifications
		Diagnosis
		Extent of Removal
		Technical Difficulties
		Associated Complications
		Preoperative Gonadotropin-Releasing Hormone Agonists
		Vasopressin
		Defect Closure
		Laparoscopic Uterine Artery Occlusion or Ligation
		Timing of Surgery
	Adhesions
		Combined Surgical Medical Treatment
		Robotic Adenomyomectomy
	Follow-up
	Conclusion
	References
Chapter 19: Morcellation Techniques for Fibroid Uterus
	Introduction
	Era of Morcellators
	Variations and Areas of Concern in Morcellation of Fibroids
	The Phase Beyond the Morcellation Controversy
	Total Health-Care Technique of Contained Visual in-Bag Morcellation of Fibroids - Uterus
	Surgical Steps of Contained Bag Morcellation
	Results
	Discussion
	Conclusion
	References
Chapter 20: Parasitic Fibroids
	Introduction
	Pathogenesis
	Location
	Treatment
	Conclusion
	References
Chapter 21: Laparoscopic Hysterectomy in the Setting of Large Fibroids
	Prerequisites for a Smooth Surgery
		Patient Position
	Port Placement
	Methods to Reduce Intraoperative Blood Loss
		Preoperative Methods
		Perioperative Methods
		Intraoperative
	Uterine Manipulation
		Vaginal Uterine Manipulator
		Myoma Screw as Manipulator
	Specimen Retrieval
		Vaginal Morcellation
		Bisection
		Myomectomy
		Laparoscopic Morcellation
		Minilaparotomy
	Points to Remember
	References
Chapter 22: Robotic Hysterectomy in Fibroid Uterus
	Indications for Surgical Therapy of Uterine Fibroids
	Treatment of Fibroid in Women Contemplating Pregnancy [15]
	Surgical Procedure Robotic Hysterectomy
	Complications
	Complication Rates in Robotic versus Laparoscopic Approach [20]
	Robotic VERSUS Laparoscopic Approach
	Conclusion
	References
Index