Myomectomy - Repairing the myoma bed

This is part of a video series within a learning module about myomectomy designed for OBGYN residents at St. Paul Hospital Millennium Medical College. The surgeon featured is Dr. Malede Birara, Assistant Professor within the Department of Obstetrics and Gynaecology. The full learning module is available at http://open.umich.edu/education/med/oernetwork/med/ob-gyn/myomectomy/2013. The video and learning module are shared under a Creative Commons Attribution Non-Commercial Share Alike 3.0 License: http://creativecommons.org/licenses/by-nc-sa/3.0/. The video was filmed and editd by Kathleen Omollo from University of Michigan and Yetemwork Abay Benti from St. Paul Hospital Millennium Medical College.

In this video as it is quite visible, once the myoma is removed or taken out

then a big cavity will be formed where the myoma has been

existing. The initial step in the repair of the myoma is the

repair the bed of the of the myoma

which is the bed where the myoma has been existing.

Unless this cavity is effectively obliterated by strong stitch like Vicryl #2 or #1

then it will collect bleeders from the surface

from the bed then it will cause hemorrhage

which is unwanted side effect of the surgery.

So to avoide such hemorrhage into the cavity or the bed of the myoma,

we have to ??? surrounding suture using Vicryl stitch is #1 or #2 of choice

and once the myoma cavity is obliterated

effectively, the rest of the uterus or the uterine incision should be repaired

in layers. Which means the myometrium should be

sutured by Vicryl stitch running, and the

serosa should also be sutured by Vicryl stitch #0, using the

baseball technique of approximating the serosa

of the uterus.

Effective covering up of the uterine incision by the serosa layer is important because

during the process of healing it may form adhesion with the bowel, with the bladder

and subsequently if the woman is to have a

caesarean section or repeat myomectomy it is going to be difficult

so the initial surgery should be properly closed

Once the uterine incisions are done

the surgeon has to make sure that hemostasis is effectively controlled

which means there is no bleeders from the incision site.

And if there are any, then it should be strengthened

by applying uninterrupted figure 8 stitch at the site of the bleeder

or by applying cautery. Once the bleeding

is controlled, the uterus can be replaced back

into the abdominal cavity for abdominal wall repair.