Day 1: Postgraduate Course - Saturday November 9, 2019

MYO-613 | Multiple Modalities of Myomectomy

Date

Saturday, November 9, 2019

Time

12:30 pm – 4:30 pm

Location

TBD

Type

Didactic

Fee

$125

Co-Chair

William H. Parker, Matthew T. Siedhoff

Faculty

Mireille D. Truong, Kelly N. Wright

Course Description

This course provides a comprehensive review of the principles and techniques of various modalities of uterine-preserving myomectomy for fibroids. Video will be used extensively to illustrate techniques that allow successful outcomes. For centuries, the “preferred” surgery for women with these benign growths has been removal of the entire organ (i.e., hysterectomy), but the reasons for that preference—that hysterectomy is safer, and a better operation―will be questioned by review of the medical literature. The course will demonstrate, with high-quality evidence and video presentation, all of the modalities of minimally-invasive myomectomy, including hysteroscopy, laparoscopy, robotic-assisted, and laparotomy. We will also demonstrate appropriate workup to optimize patients for the OR and discuss how to counsel and manage these women postoperatively.

Course Objectives

At the conclusion of this activity, the participant will be able to: 1) Complete an appropriate workup for patients undergoing myomectomy; 2) choose the appropriate route of surgery for the individual fibroid pathology; 3) describe instruments and surgical techniques for different approaches to myomectomy; and 4) counsel patients on the risk of leiomyosarcoma.

Course Outline

12:30Welcome, Introductions, and Course OverviewW.H. Parker, M.T. Siedhoff
12:35Myomectomy vs. Hysterectomy: Rationale, Safety, and Outcome Data
  • Debunking myths of myomectomy
  • LMS risk
  • Myoma “recurrence”
  • W.H. Parker
    1:00Preoperative Evaluation and Optimization:
  • Exam, US, SIS, MRI, LDH, EMB
  • Choosing the appropriate route of surgery, fertility issues
  • Correction of anemia, Iron infusions, GnRH, Ulipristal
  • Pre-op meds—tranexamic acid/misoprostol/vasopressin/tourniquets
  • M.T. Siedhoff
    1:25Hysteroscopic Myomectomy:
  • Instruments and Techniques for resection, morcellation, cold loop
  • K.N. Wright
    1:50Laparoscopic Myomectomy: Instruments and TechniquesM.T. Siedhoff
    2:15Questions & AnswersAll Faculty
    2:25Break
    2:40Robotic-Assisted Myomectomy: Instruments and TechniquesM.D. Truong
    3:05Tissue Extraction:
  • Uncontained extraction
  • Contained extraction
  • W.H. Parker, M.D. Truong
    3:30Abdominal Myomectomy: A Minimally-Invasive Alternative to Laparoscopic Hysterectomy, Instruments and TechniquesW.H. Parker
    3:55Postop Management:
  • ERAS for open and MIS cases
  • Mode of future obstetric delivery, risk of uterine rupture
  • K.N. Wright
    4:20Questions & AnswersAll Faculty
    4:30Adjourn