Course Faculty: Arnold P. Advincula, MD, Hye-Chun Hur, MD, MPH, Mireille D. Truong, MD, Kelly N. Wright, MD

This course provides a comprehensive review of the principles and techniques of various modalities of uterine-preserving myomectomy for fibroids. Faculty will use video extensively to illustrate techniques that allow successful outcomes.

For centuries, the “preferred” surgery for women with these benign growths has been the removal of the entire organ (i.e., hysterectomy). But the reasons for that preference—that hysterectomy is safer and a better operation—will be questioned by a review of the medical literature. The course will demonstrate, with high-quality evidence and video presentation, including all modalities of minimally invasive myomectomy--hysteroscopy, laparoscopy, robotic-assisted, and laparotomy. We will also demonstrate appropriate workup to optimize patients for the OR and discuss how to counsel and manage these women postoperatively.

Course Objectives:

At the conclusion of this activity, the participant should be able to:
1) Complete an appropriate workup for patients undergoing myomectomy
2) choose the appropriate route of surgery for the individual fibroid pathology
3) describe instruments and surgical techniques for different approaches to myomectomy
4) review how to counsel patients on the risk of leiomyosarcoma.

Course Outline:

 1:00 pm – 1:05 pm                  Welcome, Introductions, and Course Overview – Matthew T. Siedhoff, MD

1:05 pm – 1:30 pm                  Myomectomy vs. Hysterectomy: Rationale, Safety, and Outcome Data – Matthew T. Siedhoff, MD

• Debunking myths of myomectomy
• LMS risk
• Myoma “recurrence”

1:30 pm – 1:50 pm                  Preoperative Evaluation and Optimization - Mireille D. Truong, MD

• Exam, US, SIS, MRI, LDH, EMB
• Choosing the appropriate route of surgery, fertility issues
• Correction of anemia, Iron infusions, GnRH, Ulipristal
• Pre-op meds—tranexamic acid/misoprostol/vasopressin/tourniquets

1:50 pm – 2:20 pm                  Hysteroscopic Myomectomy – Kelly N. Wright, MD
                                                Instruments and Techniques for resection, morcellation, cold loop                                         

2:20 pm – 2:50 pm                  Laparoscopic Myomectomy: Instruments and Techniques - Matthew T. Siedhoff, MD

2:50 pm – 3:00 pm                 Questions/Answers

3:00 pm – 3:10 pm                  Break 

3:10 pm – 3:40                        Robotic-Assisted Myomectomy: Instruments and Techniques - Arnold P. Advincula, MD

3:40 pm – 4:10 pm                  Tissue Extraction - Mireille D. Truong, MD

• Uncontained extraction
• Contained extraction

4:10 pm – 4:30 pm                  Abdominal Myomectomy: A Minimally Invasive Alternative to Laparoscopic Hysterectomy, Instruments and Techniques-Hye-Chun Hur, MD, MPH

4:30 pm – 4:50 pm                  Postop Management - Kelly N. Wright, MD

• ERAS for open and MIS cases
• Mode of future obstetric delivery, risk of uterine rupture

4:50 pm – 5:00 pm                  Questions/Answers

5:00                                         Adjourn