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Vaginal transisthmic myomectomy: a step by step video tutorial.
Lejla Sandrieser1, Heinrich Husslein1, Alexandra Perricos1
1Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria.
Fertility and Sterility
|September 26, 2022
Summary
Vaginal transisthmic myomectomy offers a minimally invasive alternative for large submucosal fibroids, presenting a faster, simpler technique with basic equipment. This approach may prevent complications associated with hysteroscopic surgery.
Area of Science:
- Gynecologic surgery
- Minimally invasive procedures
- Uterine fibroid management
Background:
- Submucosal fibroids cause significant gynecological issues like heavy bleeding and infertility.
- Hysteroscopic resection is standard but can be lengthy and complex for large fibroids.
- Alternative minimally invasive techniques are needed, especially where specialized equipment is scarce.
Observation:
- A case study details vaginal transisthmic myomectomy for a 5 cm submucosal fibroid causing severe symptoms.
- The procedure involves cervical and isthmic transection, fibroid morcellation, and multilayer reconstruction.
- This technique utilizes only basic surgical instruments.
Findings:
- Vaginal transisthmic myomectomy is a rapid and straightforward minimally invasive option.
- It is suitable for large or multiple International Federation of Gynaecology and Obstetrics (FIGO) 0 and some FIGO 1 submucosal fibroids.
- The technique requires only basic surgical equipment, enhancing accessibility.
Implications:
- This approach can mitigate risks of prolonged hysteroscopic surgery and incomplete resections.
- It offers an alternative to transabdominal myomectomy, reducing associated morbidity.
- Further investigation is warranted to establish this technique's broader clinical utility.
