From Suction Curet or
for Correction of
Resection by Loop
Procedure (LEEP) for
Correction of a Double
Richardson Composite Operation
and Without Bilateral
When a myoma is demonstrated to be the cause of infertility in a patient
who wants to have a child or when a patient is otherwise opposed to
complete hysterectomy, myomectomy is indicated.
Physiologic Changes. When the fibroid tumor is removed
from the uterus, the physiologic relationship between the endometrium
and myometrium is restored, and excessive uterine bleeding should cease.
With the patient in the dorsal supine position,
an incision is made into the abdominal cavity, through either
a midline or a Pfannenstiel approach.
The uterus is exposed, the bowel is packed
off, and the fibroid tumor is identified.
With needlepoint cautery, the surgeon transects
adhesions from intestine to the uterus.
An incision is made in the
serosal surface of the uterus through the myometrium down to
the myoma. An Allis clamp is applied to one edge of the incision,
and the incision is elevated. A finger or hemostatic forceps
is used to sweep the myometrium off the fibroid tumor.
A towel clip is used to grasp the fibroid
tumor, and traction and/or countertraction is used to elevate
the fibroid tumor out of the myometrium. A pedicle of fibrous
tissue is reached. This is severed with Metzenbaum scissors or
the needlepoint electrocautery, and the tumor is removed.
Any additional fibroids are
located and grasped with a towel clip, elevated, and dissected
out in a similar manner.
If excessive myometrium and serosa are present,
these should be trimmed away.
The myometrium should be closed in two layers
with 2-0 synthetic absorbable sutures.
The serosa is reapproximated with 4-0 absorbable