Myomectomy/Hysterectomy

Myomectomy
The removal of Uterine fibroids


• What kind of fibroids are these?
Indications
• Anemia
– Secondary to uterine bleeding
• Chronic severe pelvic pain
• Chronic secondary dysmenorrhea
• Prevents examination of adnexa
• Urinary tract symptoms due to fibroids
• Growth of fibroid
• Infertility

Instruments
• Major Set With extra allis clamps
• O’connor O’Sullivan retractor or
Balfour Retractor
Positioning/Prep
The Procedure
• Midline or Pfannenstiel incision

Abdominal Hysterectomy
Hysterectomy Set

Hysterectomy
The Procedure

Vaginal Hysterectomy
Position and Instrumentation
• High lithotomy
• Perineal prep including the vagina
• Instrumentation
– Vaginal hysterectomy set
The procedure
• Weighted speculum and deaver retractor are placed in the vagina
• The cervix is grasped with a tenaculum


• A circumferential incision is made around the cervix
• The anterior cuff and peritoneum is opened and the deaver is placed in the incision to retract the bladder
• The posterior cuff and peritoneum is opened and the speculum is replaced with the Crisp speculum

• The uterosacral ligaments are grasped with heany clamps and are tagged with suture
• Just as in the open hysterectomy the dr will place a heany clamp, cut with a #10 knife and suture with pop offs.
• When they reach the uterine artery and round ligaments they are clamped and double ligated.

• The uterus is freed and delivered through the vagina
• The vaginal cuff is closed.

• When do you do your first closing count?


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