How to perform a successful myomectomy

Devin Garza, MD, FACOG, St. David’s HealthCare, and assistant clinical professor, Department of Women's Health, University of Texas Dell Medical School, Austin, Texas,

provided strategies on how to perform a successful myomectomy at AAGL’s 50th Global Congress on MIGS in Austin, Texas.

During his presentation, Garza discussed reproducible strategies to facilitate an efficient and safe robotic approach to myomectomy and demonstrated operative strategies through clinical video examples.

Nearly 80% of women prefer to avoid hysterectomy to treat their uterine fibroids regardless of their desire for future fertility, said Garza.

This is where minimally invasive gynecologic surgeries (MIGS) such as myomectomy come into play. The benefits of using MIGS includes a shorter recovery time. Fewer complications, less expensive, decreased readmissions, and more.

However, the challenges of MIGS includes complex pathology such as limited exposure (large uterus) and distorted anatomy (adhesions endometriosis).

“When it comes to fibroids, everybody knows not everyone in the U.S. has the same amount of fibroid incidence, but it all depends on key factors—the size, the number, the location,” Garza said. “And so, your strategy with myomectomies is the same thing. How many are there? How big is their weight? Where are they located?”

To set yourself up for a successful robotic myomectomy, Garza suggests implementing patient selection and preoperative planning, as well as minimizing blood loss during the procedure, maximizing efficiency, and tissue extraction strategy.

When it comes to patient selection, he emphasized surgeon confidence using their experience, proficiency, and efficiency in determining the size, number, location, and extraction strategy of the uterine fibroids.

Garza also stressed the importance of utilizing an MRI for preoperative planning to gain a better sense of what you are dealing with.

When it comes to port placement, Garza said his placements are not in a straight line with the camera placed in the umbilicus and he always uses a 4th arm. He also touched on the instrumentation he utilizes in surgery.

“Most of the time I can do a case without the scissors, so I just have to have those scissors in my hand. I also love the tenaculum for myomectomies. You’ve got to have it.” he said.

Finally, Garza left the audience with his biggest tip, “Keep cutting until the fibers stop splitting. I can’t say it anymore simple than that.”

Reference:

1. Garza D. Strategies for a Successful Myomectomy. Presented at: MIGS in Austin, Texas; November 14, 2021; Austin, Texas.