0:00:04.514,0:00:19.430
In this video as it is quite visible, once the myoma is removed or taken out

0:00:19.430,0:00:21.892
then a big cavity will be formed where the myoma has been

0:00:21.892,0:00:26.605
existing. The initial step in the repair of the myoma is the

0:00:26.605,0:00:31.374
repair the bed of the of the myoma

0:00:31.374,0:00:34.569
which is the bed where the myoma has been existing.

0:00:34.569,0:00:43.486
Unless this cavity is effectively obliterated by strong stitch like Vicryl #2 or #1

0:00:43.486,0:00:49.581
then it will collect bleeders from the surface

0:00:49.581,0:00:52.249
from the bed then it will cause hemorrhage

0:00:52.249,0:00:56.534
which is unwanted side effect of the surgery.

0:00:56.534,0:01:01.090
So to avoide such hemorrhage into the cavity or the bed of the myoma,

0:01:01.090,0:01:11.681
we have to ??? surrounding suture using Vicryl stitch is #1 or #2 of choice

0:01:11.681,0:01:21.393
and once the myoma cavity is obliterated

0:01:21.393,0:01:26.777
effectively, the rest of the uterus or the uterine incision should be repaired

0:01:26.777,0:01:32.615
in layers. Which means the myometrium should be

0:01:32.615,0:01:37.953
sutured by Vicryl stitch running, and the

0:01:37.953,0:01:45.348
serosa should also be sutured by Vicryl stitch #0, using the

0:01:45.348,0:01:49.796
baseball technique of approximating the serosa

0:01:49.796,0:01:53.648
of the uterus.

0:01:53.648,0:01:59.414
Effective covering up of the uterine incision by the serosa layer is important because

0:01:59.414,0:02:08.951
during the process of healing it may form adhesion with the bowel, with the bladder

0:02:08.951,0:02:13.861
and subsequently if the woman is to have a

0:02:13.861,0:02:17.708
caesarean section or repeat myomectomy it is going to be difficult

0:02:17.708,0:02:24.884
so the initial surgery should be properly closed

0:02:24.884,0:02:30.678
Once the uterine incisions are done

0:02:30.678,0:02:36.687
the surgeon has to make sure that hemostasis is effectively controlled

0:02:36.687,0:02:40.933
which means there is no bleeders from the incision site.

0:02:40.933,0:02:45.740
And if there are any, then it should be strengthened

0:02:45.740,0:02:51.031
by applying uninterrupted figure 8 stitch at the site of the bleeder

0:02:51.031,0:02:57.252
or by applying cautery. Once the bleeding

0:02:57.252,0:03:04.824
is controlled, the uterus can be replaced back

0:03:04.824,9:59:59.000
into the abdominal cavity for abdominal wall repair.