WEBVTT

00:00:03.559 --> 00:00:08.287
Before starting the myomectomy procedure, the

00:00:08.287 --> 00:00:11.521
surgeon has to pull up the bowel

00:00:11.521 --> 00:00:15.628
with the sterile pack

00:00:15.628 --> 00:00:19.327
so that the bowel will be retracted upwards

00:00:19.327 --> 00:00:25.403
and to facilitate proper and easier visualization

00:00:25.403 --> 00:00:26.754
of the surgical field.

00:00:26.754 --> 00:00:33.376
After proper preparation of retraction of the bowel and

00:00:33.376 --> 00:00:41.016
then insertion of the retractor to widen the surgical field

00:00:41.016 --> 00:00:42.605


00:00:42.605 --> 00:00:48.827
then the next step is to apply tonically?

00:00:48.827 --> 00:00:54.430
because the most important step in a myomectomy is to conduct the surgery with

00:00:54.430 --> 00:00:56.431
less blood loss

00:00:56.431 --> 00:01:01.673
thus, hemostatis or decreasing hemhorrage is a very important step in myomectomy

00:01:01.673 --> 00:01:05.373
because myomectomy is going to be a blind x unless you

00:01:05.373 --> 00:01:09.780
conduct in a way which decrease blood loss

00:01:09.780 --> 00:01:12.308
the interoperative blood loss might be very high.

00:01:12.308 --> 00:01:18.812
There are different techniques but the common method which we use is to apply

00:01:18.812 --> 00:01:24.226
tonicity, which is to use a #8 catheter.

00:01:24.226 --> 00:01:25.904
So we open a window on both sides of

00:01:25.904 --> 00:01:28.367
lateral aspect of the utuerus, then tightly

00:01:28.367 --> 00:01:38.042
close it or suture it, or wrapping the catheter

00:01:38.042 --> 00:01:41.257
so that catheter is going to occlude the

00:01:41.257 --> 00:01:47.263
the uterine arteries on both sides and then decrease the blood flow to the upper part of the uterus

00:01:47.263 --> 00:01:49.099
thereby decrease the blood loss.

00:01:49.099 --> 00:01:53.272
So after applying a tonicy on the lower aspect of the utuerus

00:01:53.272 --> 00:01:58.927
sometimes, depending on the need, the size of the myoma, the tonicy ?

00:01:58.927 --> 00:02:02.567
also on the ovarian vessels might be needed

00:02:02.567 --> 00:02:07.288
but usually tonicy applied on the uterine vessels is usually sufficient

00:02:07.288 --> 00:02:12.909
Currently one can apply or inject a vassopressin

00:02:12.909 --> 00:02:19.616
which is a kind of drug which will decrease the blood loss to the myoma

00:02:19.616 --> 00:02:23.616
and then you can conduct the surgery.