Magdy Milad, MD

The case presented is that of a 40 year-old woman who has been bleeding for the past 60 days as a result of this 3 cm intracavitary fibroid. Visualizing the fibroid by hysteroscopy reveals a large 3 cm specimen with large vessels that are feeding the fibroid tissue. As a result the decision was made to inject dilute Pitressin (vasopressin) in order to cause vasospasm of the vessels and decrease the complication rate, fluid absorption, and bleeding at the time of hysteroscopic resection.

Here the cervix is injected, and the needle is placed at level of the lower segment of the uterus. Following injection of dilute Pitressin for hysteroscopy reveals a pale specimen with vessels that have been contracted and constricted. A Myosure device is being used now to resect the fibroid. Myosure was developed in 2009 and at a rate of 6,000 revolutions per minute, is able to remove 1.5 grams per minute. Despite the fact that the specimen is quite hard, the morecellator is able to remove it in a very sequential and progressive way, with remarkably little bleeding despite the large vessels that we saw earlier. The tissue gets drawn into the morecellating window, and the mechanical morcellator chops it and suctions the tissue away.

Here approximately half of the fibroid has been removed, and the pale tissue is visible with remarkably little bleeding.

Here three quarters of the specimen has been now removed and we’re starting to see the level of the normal endometrium. The last remaining pieces are divided and suctioned, and now we’ve achieved 100% removal.

The uterine cavity is now deinsufflated to demonstrate that there are no remaining pieces of fibroid in the cavity or wall of the uterus that could extrude. A small polyp is now removed to create a perfect endometrial environment.
 


 
Since 1995, Dr. Magdy Milad has been the Director of Gynecologic Endoscopy at Northwestern University, and is the Division Chief for Graduate Medical Education. He has authored 80 peer-reviewed manuscripts and 90 national presentations, and has developed an expertise in advanced minimally invasive surgeries including laparoscopy, hysteroscopy for conditions including endometriosis, fibroids, adhesions, tubal disease and ovarian cysts.
 

Articles

This surgical video shows resection of a 3-cm intracavity fibroid using minimally invasive surgical technology. The patient, a 40-year-old woman, presented with a 60-day history of abnormal bleeding.

VIDEO: Myosure Resection of Fibroid

This patient presented with 18 months of secondary infertility following a second trimester dilation and extraction. Upon entry into the uterine cavity with the hysteroscope, we immediately noticed three fragments of foreign material at the uterine fundus. We used the polyp graspers to carefully extract the first fragment of foreign material, keeping it within direct visualization of the hysteroscope as it was slowly removed from the uterine cavity. We then returned into the cavity and extracted the remaining two fragments in a similar fashion, again being careful to keep them in direct visualization. We confirmed with ultrasound at the end of the procedure that all fragments had been removed, and they appeared consistent with fetal bone on gross examination.

Since 1995, Dr. Magdy Milad has been the Director of Gynecologic Endoscopy at Northwestern University, and is the Division Chief for Graduate Medical Education. He has authored 80 peer-reviewed manuscripts and 90 national presentations, and has developed an expertise in advanced minimally invasive surgeries including laparoscopy, hysteroscopy for conditions including endometriosis, fibroids, adhesions, tubal disease and ovarian cysts.
 

This patient presented with 18 months of secondary infertility following a second trimester dilation and extraction.

Hysteroscopic Removal of Calcified Fragments

This video demonstrates a case in which an intrauterine device (IUD) IUD was trapped--not in the uterine cavity and not outside the uterine wall, but within the muscle of the uterus. It was extracted under laparoscopic guidance.


 
Since 1995, Dr. Magdy Milad has been the Director of Gynecologic Endoscopy at Northwestern University, and is the Division Chief for Graduate Medical Education. He has authored 80 peer-reviewed manuscripts and 90 national presentations, and has developed an expertise in advanced minimally invasive surgeries including laparoscopy, hysteroscopy for conditions including endometriosis, fibroids, adhesions, tubal disease and ovarian cysts.

VIDEO: Trapped IUD Extracted via Laparoscopy

This procedure was performed to remove an intracavitary fibroid that failed hysteroscopy on two occasions. The patient continued to experience heavy bleeding and an advanced laparoscopic myomectomy was performed with a thorough repair of the uterine muscle to prepare for future pregnancy. Blood loss was minimal.

This procedure was performed to remove an intracavitary fibroid that failed hysteroscopy on two occasions.

Magdy Milad, MD

Articles

VIDEO: Myosure Resection of Fibroid

Hysteroscopic Removal of Calcified Fragments

VIDEO: Trapped IUD Extracted via Laparoscopy

VIDEO: Laparoscopic Removal of Intracavitary Uterine Fibroid