Endometriosis, Cervical and Broad Ligament Leiomyomas: How to Avoid Injuries
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The challenges while operating in cases of endometriosis and cervical and broad ligament leiomyomas are the fact that the lesion can be very close to the ureter. There could be ureteric compression and hydroureter in long-standing cases. In addition, endometriosis is known to involve the bowel. The condition might require uretric reimplantation if the ureters are involved. Resection anastomosis of the involved segment may be required if the disease involves the bowel. The urological component of the surgery has to be done with a urologist, and bowel resection and anastomosis have to be done with a surgeon. The fundamental principles of operating in such cases are use of sharp dissection and locating the ureter early in the course of dissection in order to avoid ureteric injuries. One must try to excise all the endometriotic tissues in order to avoid recurrence. In case of leiomyomas, one must try and avoid morcellation of the specimen if the leiomyoma is very large, soft, and fleshy and appears on gross examination like a sarcoma. Before considering myomectomy for improving fertility, options like IVF and surrogacy must be discussed since successful removal of leiomyomas and conception are two different issues. During myomectomy for improving fertility, the leiomyoma(s) must be removed without incising the uterine cavity or must be removed through a single incision in the uterine cavity. The risks of preterm labor, uterine rupture, placenta previa, and placenta accreta are high if the uterine cavity is opened during myomectomy.
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