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Fig. 1 | Gynecological Surgery

Fig. 1

From: Laparoscopic myomectomy using endoscopic loops under progressive tension

Fig. 1

Use of endoscopic loops during laparoscopic myomectomy for fibroids with at least a subserosal component. The technique depends on the volume of the intramural component. a Fibroids which are mainly subserosal or pedunculated with a large stalk are characterised by an acute angle between themselves and the uterine wall. That constitutes a comfortable groove where the loop is easily applied and tension exerted. The serosa overlying the fibroid is then incised with a monopolar electrode until the myomatous fibres are exposed. b Fibroids which are mainly intramural might not offer the same acute angle with the healthy tissue. We begin with an incision over the tumour. Once the fibroid is reached, it is grasped and tractioned towards the uterine surface so that it is virtually converted into a subserosal one. The loop can now be applied, and the intervention continues by following a common pathway. Illustrations by Dr. Pietro Gambadauro

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