Cesarean Myomectomy

Intra-cavitary Approach-
An Innovative Technique

Dr Girija Shankar Mohanty

(SR,Dept. Of Obg,AIIMS,BBSR)
Yesterday’s Contraindications

Are

Today’s Indications
Age Old Teaching & Practice

 Myomectomy during CS is absolutely

contraindicated
 It’s a next door to Manslaughter
– Risk of Hemorrhage

– Future Scar Integrity

– Possibility of increased infections

 Consensus

 Subserous pedunculated myoma

 Myoma over the lower segment on
anterior wall over proposed site of
lower segment incision
 Myoma undergoing torsion
 Resurgence of Concept

 Controlled hemostasis
 Avoidance of repeat surgery
 Better cleavage
 Effective ecbolics
 Smart Surgeons ?
 Location of myoma – No option left
 Special Techniques

 Vasopressin as a hemostatic agent

 Choice of effective uterotonic

 Hemostatic closures

 Preop devascularisation

 Post myomectomy compression suture

Newer Surgical Approach for
Cesarean Myomectomy

Intra-cavitary Approach
 SUMMARY
BENEFITS-

 Avoidance of repeat surgery

 Psychologically gratifying for patient
 Cost effective
 Why intra-cavitary approach?

 Less bleeding
 Easy suturing
 No adhesion
 Scar integrity better