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THE SEVEN SINS OF MYOMECTOMY

THE SEVEN SINS OF MYOMECTOMY. Professor T C Li Sheffield, England. Shenzhen, May 2013. Two types of sin. Minor or Venial Deadly or Cardinal (seven).

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THE SEVEN SINS OF MYOMECTOMY

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  1. THE SEVEN SINS OF MYOMECTOMY Professor T C Li Sheffield, England Shenzhen, May 2013

  2. Two types of sin • Minor or Venial • Deadly or Cardinal (seven)

  3. Sail away where no ball and chainCan keep us from the roarin' wavesTogether undivided but forever we'll be freeSo sail away aboard our rigThe moon is full and so are weWe're seven drunken piratesWe're the seven deadly sinsWe're seven drunken piratesWe're the seven deadly sinsWe're seven drunken piratesWe're the seven deadly sins [ Seven Deadly Sins Lyrics on http://www.lyricsmania.com/ ] Send "Seven Deadly Sins" Ringtone to your Cell

  4. a painted rectangle with a central image of the eye of God, with Christ watching the world. The Seven Deadly Sins , depicted ... WebMuseum: Bosch, Hieronymus: The Seven Deadly Sins

  5. WHAT ARE THE SEVEN DEADLY SINS?

  6. LUST 好色

  7. 贪食

  8. 贪婪

  9. 懒惰

  10. 愤怒

  11. 妒忌

  12. 骄傲

  13. WHAT ARE THE SEVEN SINS OF MYOMECTOMY?

  14. SIN 1SLOTH Not bother to do myomectomy when it is indicated

  15. NOT DOING MYOMECTOMY WHEN IT IS INDICATED 懒惰

  16. Excuses • Risk of losing the uterus • Risk of adhesion • Risk of scar rupture • Risk of operation • Risk of transfusion • Other risks….

  17. CASE HISTORY • 33 year old women, 4cm intramural fibroid • Two 2 first trimester miscarriage, one second trimester loss • Consulted a gynaecologist who thought myomectomy not indicated because it was less than 5cm • One more miscarriage • She sought a second opinion, had myomectomy • Afterwards, a successful term delivery

  18. In considering whether or not to perform a myomectomy, there are three important factors. • Location • Size • Reproductive History

  19. Leaving fibroid behind may create problems for the future

  20. Leaving fibroid behind may create problems for the future There are various obstetric complications associated with fibroids

  21. CASE HISTORY • 5cm anterior wall intramural fibroid • Conceived • Oblique lie • LSCS • Fibroid 10cm in lower segment • Great difficulty in delivering baby – took 10 min • Lost 8 litres of blood • Caesarean hysterectomy

  22. SIN 2GREED Too eager, doing myomectomy when it is not indicated

  23. DOING MYOMECTOMY WHEN IT IS NOT INDICATED 贪婪

  24. CASE HISTORY • 45 year old women • Noticed abdominal swelling • Scan 8cm fibroid • Periods not heavy • No pain • ‘Doctor, should I have the fibroid removed?’

  25. Prior to undertaking myomectomy, two requirements must be fulfilled : • Sufficient indication for treatment (any treatment) • Sufficient justification for myomectomy instead of other forms of treatment

  26. CASE HISTORY Age 45, menorrhagia and prolonged periods Anaemia 8 g/dl 5 cm intramural fibroid Is there sufficient indication for myomectomy?

  27. Surgery is an admission that medical treatment has failed or not possible

  28. TREATMENT OPTIONS • No treatment • Medical • UAE • Surgical

  29. CASE HISTORY Age 45, menorrhagia and prolonged periods Anaemia 8 g/dl 5 cm intramural fibroid Mirena coil – excellent result Surgery not required

  30. MIRENA COIL • Suitable • Normal or only slightly enlarged uterus • Cavity not distorted • Not suitable • Submucous fibroid/polyp • Uterus significantly enlarged

  31. A good surgeon learns how to operate

  32. A good surgeon learns how to operate A great surgeon knows when not to operate

  33. SIN 3 ARROGANT, NOT TAKING SAFETY MEASURES

  34. 骄傲

  35. ULTRASOUND CONTROL SHOULD ALWAYS BE CONSIDERED IN TCRM OF TYPE II SUBMUCUS FIBROID

  36. SUBMUCOUS FIBROID

  37. ULTRASOUND EVALUATION & CONTROL

  38. OTHER SAFETY MEASURES • Monitor of fluid balance in TCRM • The use of Foley catheter tamponade after TCRM (Yu et al 2006) • Cervical priming to reduce trauma to cervix during dilatation (Yu et al 2006) • Judicious use of morcellator

  39. SIN 4 LUXURIA (Lust)

  40. LUST 好色

  41. Too pre-occupied with the body appearance; Too vain Not enough attention to the internal affairs

  42. Laparoscopic Myomectomy

  43. CASE HISTORY • 38 year old women • Experiences chronic pelvic pain ever since myomectomy

  44. CASE HISTORY • 38 year old women • Experiences chronic pelvic pain ever since myomectomy • Required regular strong analgesics • Frequent time off work

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