Home / Site Map / Vulva and Introitus / Vagina and Urethra / Bladder and Ureter / Cervix / Uterus
Fallopian Tubes and Ovaries / Colon / Small Bowel / Abdominal Wall / Malignant Disease: Special Procedures


Dilatation and Curettage

Suction Curettage
for Abortion

Management of Major
Uterine Perforations
From Suction Curet or
Radium Tandem

Cesarean Section


Jones Operation
for Correction of
Double Uterus

Hysteroscopic Septal
Resection by Loop
Electrical Excision
Procedure (LEEP) for
Correction of a Double

Manchester Operation

Richardson Composite Operation

Total Vaginal Hysterectomy

Total Abdominal
Hysterectomy With
and Without Bilateral

Laparoscopy-Assisted Vaginal Hysterectomy


When a myoma is demonstrated to be the cause of infertility in a patient who wants to have a child or when a patient is otherwise opposed to complete hysterectomy, myomectomy is indicated.

Physiologic Changes. When the fibroid tumor is removed from the uterus, the physiologic relationship between the endometrium and myometrium is restored, and excessive uterine bleeding should cease.


With the patient in the dorsal supine position, an incision is made into the abdominal cavity, through either a midline or a Pfannenstiel approach.

The uterus is exposed, the bowel is packed off, and the fibroid tumor is identified.

With needlepoint cautery, the surgeon transects adhesions from intestine to the uterus.

An incision is made in the serosal surface of the uterus through the myometrium down to the myoma. An Allis clamp is applied to one edge of the incision, and the incision is elevated. A finger or hemostatic forceps is used to sweep the myometrium off the fibroid tumor.

A towel clip is used to grasp the fibroid tumor, and traction and/or countertraction is used to elevate the fibroid tumor out of the myometrium. A pedicle of fibrous tissue is reached. This is severed with Metzenbaum scissors or the needlepoint electrocautery, and the tumor is removed.

Any additional fibroids are located and grasped with a towel clip, elevated, and dissected out in a similar manner.

If excessive myometrium and serosa are present, these should be trimmed away.

The myometrium should be closed in two layers with 2-0 synthetic absorbable sutures.

The serosa is reapproximated with 4-0 absorbable suture.


Copyright - all rights reserved / Clifford R. Wheeless, Jr., M.D. and Marcella L. Roenneburg, M.D.
All contents of this web site are copywrite protected.