Laparoscopy – Locating fibroids during Laparoscopic Myomectomy

Removal of fibroids by laparoscopy (Laparoscopic Myomectomy) is perhaps the most tedious of all laparoscopic surgeries. There are many steps namely:Devascularize the uterusRemoval of the fibroidsRepair the defectRemoval of the fibroid/s by morcellationMy biggest fear when performing myomectomy by laparoscopy is missing fibroids. There are several strategies for not missing a fibroid when performing this surgery. They are:Transvaginal ultrasound during the surgeryTransvaginal injection of methylene blue dye on the capsule of the fibroid MinilaparotomyIntraoperative ultrasound Transvaginal ultrasound during the surgery This can be done easily. Once all the visible fibroids are removed by laparoscopy, a transvaginal ultrasound (TVS) can be done to look at the uterus to see if there are any fibroids that are still remaining in the uterus. One trick is to place some fluid in the Pouch of Douglas and place the patient in the reverse Trendelenburg position when performing the transvaginal ultrasound. The advantage of this method is that it is easy to find an ultrasound with a