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Laparoscopic Myomectomy by Steven McCarus, MD
Authored by
Steven McCarus, MD
Authored by
Steven McCarus, MD
Laparoscopic Myomectomy by Steven McCarus, MD
Operative Steps
Operative Steps
- The abdominal wall is elevated, an Ultra Veress Needle is placed through the umbilicus, CO2 gas is insufflated.
- A small skin incision is made at the umbilicus, then a non-bladed 5 mm trocar such as ENDOPATH XCEL™ Trocar is passed through the incision, confirmation that you are in the abdominal cavity is made with the laparoscope.
- Once the patient is in the Trendelenburg position, a 2nd and 3rd 11mm non-bladed trocars are passed through the abdominal wall.
- Once the location of the fibroid is identified, Vasopressin is injected until blanching of the tissue is noticed.
- Securing the uterus with a grasper, HARMONIC™ 1100 is then used to cut the serosa covering the fibroid. This will expose the fibroid. Using traction and countertraction, the fibroid will be disengaged from the uterus.
- Myoma vessel control is accomplished by using an energy device such as HARMONIC™ 1100 as needed.
- Use Topical absorbable hemostatic agent such as SURGICEL™ Powder Absorbable Hemostat on the fibroid site for hemostasis as necessary.
- Closure of the defect with a synthetic absorbable suture such as size 0 Vicryl-Plus suture, with CT-1 needle.
- If needed, the deep myometrium can be closed with a knotless tissue control device such as STRATAFIX™ Knotless Tissue Control Device, then followed by synthetic absorbable suture such as Vicryl-Plus suture.
- Use Topical absorbable hemostatic agent such as SURGICEL™ Powder Absorbable Hemostat on the fibroid site for hemostasis as necessary.
- The fibroid is placed in a specimen retrieval bag such as ENDOPOUCH™ RETRIEVER Specimen Bag and is extracted by mini laparotomy.
- Use Topical absorbable hemostatic agent such as SURGICEL SNoW™ Absorbable Hemostat on the suture closure approximation site.
- All trocars are removed and a synthetic absorbable suture such as 4-0 Vicryl Plus suture is used to close the trocar sites.