Yves Leroy by Tamer Seckin
Dr. Tamer Seckin
Hello, everyone. To all ISGE members all around the world, this is Dr. Tamer Seckin, Sao Paolo, Brazil. I am reporting from the joint Brazilian and ISGE Endometriosis Meeting. We have the pleasure of having here today Dr. Yves Leroy from Mexico City who will be informing about his valuable techniques on myomectomy. Yves, how are you today?
Dr. Yves Leroy
Fine. Thank you.
Dr. Tamer Seckin
I have specific questions for you. You have talked about myomectomy and I would like you to tell our viewers what are the indications for myomectomy surgery and what are the challenges and how you deal with it in your environment with those challenges?
Dr. Yves Leroy
Okay. There are many ways to treat myomas. It depends very much on what you want to achieve, that person wants to keep her uterus for reproduction or whatever the idea she wants to conserve the uterus to keep it. So, the technique of myomectomy will change. Myomectomy is a surgical procedure, but there are other nonsurgical procedures as well.
Dr. Tamer Seckin
At this meeting obviously we are talking about the surgical laparoscopic management of myomectomy. How do you stitch the uterus back and what are your criteria of cavity entrance or not, does it make any difference with the way you stitch the uterus back and how do you remove specimens?
Dr. Tamer Seckin
Okay, first of all, you have to plan your surgery, how many myomas, their location and their size. You can plan the surgery as well as time. If you do not have good instruments, you do not do that kind of surgery. To begin with, we incise the place where the myoma is and we infiltrate with Pitocin. Then we start doing what is called enucleation. We are trying not to remove any tissue which is not damaged. So, we go directly to the myoma and we use very much the technique of enucleation by going around the myoma, once where the myoma is free to come out. So we leave it there under cul-de-sac and we go after the next one. On doing that the number of myomas will be 3-4 or five and then we start the suturing process once we have mostly all the myomas out.
Dr. Tamer Seckin
Lastly, how do you remove them from the abdominal cavity?
Dr. Yves Leroy
It is very useful to have a…
Dr. Tamer Seckin
Morcellator?
Dr. Yves Leroy
Yes a morcellator. Usually the morcellator has to be electric morcellator _. Otherwise it will take you lot of time.
Dr. Tamer Seckin
Do you use cul-de-sac, do you utilize cul-de-sac?
Dr. Yves Leroy
Sometimes at the beginning, we used to go to the cul-de-sac vaginally and remove the big myomas. Anyway morcellation is the key of reducing operative time. If you do that then you will finish ending the surgery by removing, this is the last step of it, the use of the morcellator. The closing of the layers has to be in at least two layers. The myometrium has to be closed properly and this is the most difficult part of it. That is why the surgeon has to be skillful about suturing, otherwise he will take a long time to do it.
Dr. Tamer Seckin
Thank you for your time, Dr. Yves Leroy.
Dr. Yves Leroy
Okay. Thank you very much.
