Pietro Litta

Chirurgia Pelvica Mini-Invasiva e Ostetricia Operativa Dipartimento Salute della Donna e del Bambino

Università degli studi di Padova

MIOMECTOMIA LAPAROSCOPICA

MIOMECTOMIA LAPAROSCOPICA

Semm K.

New methods of pelviscopy (gynecologic

laparoscopy) for myomectomy, ovariectomy,

tubectomy and adnexectomy

Endoscopy 1979;11:85-93

chirurgia mini-invasiva

• Tempi operatori prolungati• Minor perdita ematica• Minor richiesta di terapia antalgica nel postoperat orio• Ricovero più breve• Convalescenza più breve• Tecnica più difficile• Strumentazione più costosa• Effetto estetico migliore

• DIFFICOLTA’ TECNICHE• TEMPI OPERATORI PROLUNGATI

• manovre push-pull• sanguinamento durante l’enucleazione• sanguinamento durante la sutu ra• rimozione mioma

PUNTI CRITICI

Perdita ematicaintraoperatoria

• Dimensione• Consistenza• Rete vascolare

ectasica• Tipo

Miomi:444/ 739

PERDITA EMATICA

FARMACI

STRUMENTI FILI DI SUTURA

TECNICA

Acta Anaesthesiol Taiwan. 2006 Dec;44(4):243-7.

Intramyometrial injection of vasopressin causes bra dycardia and cardiac arrest--report of two cases. Hung MH1, Wang YM, Chia YY, Chou YM, Liu K. Vasopressin has been documented to effectively reduce blood loss in gynecologic practice. However, local infiltration of vasopressin may cause lethal cardiopulmonary complications in spite of rarity of reported cases. Severe bradycardia and cardiac arrest were encountered after intramyometrial injection of vasopressin in our two healthy patients undergoing open uterine myomectomy. We herewith discuss the associated complications and the anesthetic considerations.

HARMONIC ACE

Mucosaendometriale

Group A= vasoconstrictor – electrosurgery deviceGroup B= Harmonic Ace

Fertility &Sterility,2010

uretere

Arteria uterina

OCCLUSIONE ARTERIA UTERINA

Anchor depth = ~30% into core1

Anchor angle = ~15 degrees1

Anchors per inch = 20 (8 per cm)

Spiral pattern1

STRATAFIX( sutura autobloccante)

sutura apunti staccati

sutura in continua

this kind of suture does not require knots, thus making laparoscopic myomectomy a potentially shorter and simpler procedure.

An advantage of this suture is to distribute tension regularly along the whole wound length rather than concentrating it at the site of knotting.

VANTAGGI

… GRAZIE PER L’ATTENZIONE.

Andrea Mantegna, 1485