ABSTRACT
All these techniques require mastery of vaginal surgery. They must be carried out progressively and under visual control, without excessive haste. Ripping or dilaceration of a vascular pedicle that could cause postoperative, sub-peritoneal bleeding can be prevented by exerting only moderate pull on the forceps. The assistants’ retractors have to be repositioned at every new stage. This allows rotation of the uterus, as well as access to the anterior peritoneal pouch and utero-ovarian pedicles, by operational stages that might appear exaggerated in view of the overall uterine volume…
One usually refers to techniques for uterine volume reduction, since one technique alone is usually insufficient to bring about rotation of the uterus. Rather than the mastering of a single “miracle” technique, it is desirable that a solid strategy for uterine volume reduction be developed. The surgeon must never be caught unprepared; he must control the successive techniques for uterine volume reduction, the placement of the retractors by the assistant surgeons, and he must regularly regain his anatomical orientation by clinical examination. Thus, in our experience, we usually begin by uterine hemisection, terminated with a myomectomy or by morcellation of a
Precautions
A number of rules must be followed during the reduction of uterine volume
– always work in the field of view; – do not hurry and work methodically; – regularly reposition the retractors; – pay attention to the anterior pouch (if unopened), as well as to the bladder; – do not pull excessively on the forceps; – locate the utero-ovarian pedicles if the procedure moves away from the median plane.
