Before starting the myomectomy procedure, the
surgeon has to pull up the bowel
with the sterile pack
so that the bowel will be retracted upwards
and to facilitate proper and easier visualization
of the surgical field.
After proper preparation of retraction of the bowel and
then insertion of the retractor to widen the surgical field
then the next step is to apply tonically?
because the most important step in a myomectomy is to conduct the surgery with
less blood loss
thus, hemostatis or decreasing hemhorrage is a very important step in myomectomy
because myomectomy is going to be a blind x unless you
conduct in a way which decrease blood loss
the interoperative blood loss might be very high.
There are different techniques but the common method which we use is to apply
tonicity, which is to use a #8 catheter.
So we open a window on both sides of
lateral aspect of the utuerus, then tightly
close it or suture it, or wrapping the catheter
so that catheter is going to occlude the
the uterine arteries on both sides and then decrease the blood flow to the upper part of the uterus
thereby decrease the blood loss.
So after applying a tonicy on the lower aspect of the utuerus
sometimes, depending on the need, the size of the myoma, the tonicy ?
also on the ovarian vessels might be needed
but usually tonicy applied on the uterine vessels is usually sufficient
Currently one can apply or inject a vassopressin
which is a kind of drug which will decrease the blood loss to the myoma
and then you can conduct the surgery.