Orris

myomectomy and histercotomy steps

Can you clarify first: did you mean hysterotomy (incision into the uterus, often for cesarean delivery/fetal surgery) rather than “histercotomy”?
If yes, I can give:
  1. Open abdominal myomectomy steps + key safety points, and
  2. Hysterotomy (cesarean-type uterine incision/closure) steps.

yes

myomectomy and hysterectomy

Myomectomy vs Hysterectomy: Core operative steps (high-level)
(For study/overview. Actual technique varies by surgeon, route, uterine size, fibroid burden, adhesions, and fertility goals.)

1) Myomectomy (uterus-preserving fibroid surgery)

A. Pre-op

  • Confirm indication: symptoms, infertility/recurrent loss, cavity distortion, bulk symptoms
  • Imaging mapping (US/MRI) for number, size, location (subserosal/intramural/submucosal)
  • Optimize Hb/iron; blood availability; consent for bleeding/transfusion and possible conversion

B. Intra-op (open/laparoscopic principles)

  1. Abdominal/pelvic entry and assessment
  2. Hemorrhage-reduction measures (e.g., vasopressin infiltration, temporary vascular control, uterotonics per protocol)
  3. Uterine serosal incision over fibroid (prefer longitudinal/transverse based on access and closure plan)
  4. Enucleation: develop pseudocapsule plane and shell out myoma
  5. Hemostasis of myoma bed
  6. Multilayer myometrial closure to obliterate dead space
  7. Serosal closure/re-approximation (anti-adhesion strategy as needed)
  8. Repeat for additional fibroids
  9. Specimen extraction (mini-lap or contained extraction if minimally invasive)
  10. Final hemostasis, irrigation, close abdomen/port sites

C. Post-op focus

  • Monitor bleeding, pain, ileus, infection
  • Future pregnancy counseling (risk of uterine rupture depends on depth/number of incisions)
  • Delivery planning in future pregnancy individualized

2) Hysterectomy (uterus removal)

Can be abdominal, laparoscopic/robotic, vaginal, and may be total (uterus + cervix) or supracervical (uterus only). May include salpingectomy ± oophorectomy.

A. Pre-op

  • Confirm indication and route selection
  • Cervical screening status, endometrial assessment when indicated
  • Counsel on fertility loss, risks (bleeding, urinary tract/bowel/vascular injury), menopausal implications if ovaries removed

B. Core surgical sequence (route-specific details vary)

  1. Entry and pelvic survey
  2. Divide round ligaments (if abdominal/laparoscopic route) and open broad ligament planes
  3. Bladder dissection off lower uterine segment/cervix
  4. Control uterine blood supply (uterine vessels) close to uterus
  5. Sequentially divide cardinal/uterosacral supports
  6. Colpotomy (for total hysterectomy) and remove uterus ± cervix
  7. Close vaginal cuff (if total hysterectomy)
  8. Ensure hemostasis; check urinary tract integrity when indicated
  9. Close incisions/ports

C. Post-op focus

  • VTE prophylaxis, pain control, bowel/bladder recovery
  • Watch for cuff complications (if total), hemorrhage, infection, urinary injury signs
  • Activity and intercourse restrictions until healing complete

Quick comparison

  • Myomectomy: keeps uterus, preserves fertility potential, but fibroids can recur; usually higher bleeding risk intra-op than straightforward hysterectomy.
  • Hysterectomy: definitive cure for uterine fibroid bleeding/bulk symptoms; no future pregnancy.
If you want, I can give a route-wise checklist (open vs laparoscopic vs vaginal) or an exam-style step sequence you can memorize.

A

yes give both

Great. Here is an exam-style, memorizable checklist for both:

1) Myomectomy (open/laparoscopic): step sequence

  1. Position + prep + antibiotics + uterine manipulator (if MIS)
  2. Abdominal/port entry and map fibroids
  3. Bleeding control adjunct (vasopressin/temporary devascularization as planned)
  4. Serosal incision directly over dominant fibroid
  5. Enucleate fibroid in pseudocapsule plane (traction-countertraction)
  6. Hemostasis in myoma bed
  7. Close myometrium in layers (obliterate dead space)
  8. Serosal closure to reduce adhesions
  9. Repeat for other fibroids (largest/deepest first usually)
  10. Specimen retrieval (bag/mini-lap as appropriate)
  11. Final pelvic hemostasis + irrigation
  12. Close ports/laparotomy

“Must mention” viva points

  • Main risk: hemorrhage; crossmatch blood
  • Convert to laparotomy if unsafe bleeding/poor visualization
  • Counsel on recurrence and future pregnancy plan

2) Hysterectomy (total hysterectomy): step sequence

(Works as core framework for abdominal/laparoscopic; vaginal differs in entry but same pedicle logic.)
  1. Position + prep + antibiotics + catheter
  2. Entry and inspect pelvis
  3. Round ligament division (abd/lap routes)
  4. Open broad ligament spaces and identify ureter course
  5. Bladder flap dissection off cervix/lower segment
  6. Control adnexal pedicles (utero-ovarian or infundibulopelvic, depending on ovary conservation)
  7. Skeletonize, clamp/seal, divide uterine vessels close to uterus
  8. Divide cardinal + uterosacral ligaments
  9. Colpotomy circumferentially and remove uterus + cervix
  10. Close vaginal cuff (include supportive bites as needed)
  11. Hemostasis + ureter/bladder check when indicated
  12. Closure of abdominal/port incisions

“Must mention” viva points

  • Critical safety principle: ureter awareness at every pedicle
  • Decide pre-op: total vs supracervical, salpingectomy ± oophorectomy
  • Major complications: bleeding, urinary tract injury, bowel injury, cuff issues

One-line memory aid

  • Myomectomy: Cut uterus -> shell out fibroid -> layered uterine reconstruction
  • Hysterectomy: Take pedicles systematically -> detach cervix/uterus -> close cuff
If you want, I can also give a side-by-side table: abdominal vs laparoscopic vs vaginal hysterectomy differences in 60 seconds.

give again

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