Myomectomy

Indicated in an infertile woman or woman desirous  of childbearing. n 2 retain uterus

Preoperative prerequisites
1) Hb restored.
2) other causes of infertility excluded.
3) consent 4 hysterectomy.
4) it shud b performed in preovulatory phase 2 reduce bld loss.

Types
1 Abdominal
2 Vaginal
3 Hysteroscopic
4 Laparoscopic.

Measures 2 control bld loss

1) Pre oper. Rx with GnRH analogue
2) Use of Victor Bonney clamp 2 reduce uterine artery bld flow.
3) tourniquets 2 occlude uterine n ovarian vessels
4) vasopressin 20 unit in 60ml saline inj in myometrium over myoma.
5) controlled hypotensive anaesthesia 2 reduce venous tone. n moderate deg. Trendelenberg posn.

Procedure (abdominal.) :
1) uterine incision: in midline on ant. wall of uterus n deepened thro myometrium n capsule
2) Myoma enucleated intracapsular 4m bed.
3) myoma bed obliterated by interrupted mattress or fig. of 8  sutures.

COMPLICATIONS
1) haemorrhage. Pri. sec. n reactionary
2) Injury 2 bowel bladder n ureter.
3) infection
4) adhesion n intestinal obstrn.

VAGINAL-4 submucous myoma

HYSTEROSCOPIC- sutmucous myoma excised by cautery or laser.

LAPAROSCOPIC-
1 in pedunculated fibroid.
2 subserous fibroid nt >10cm in size n nt >4 in number