[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:03.56,0:00:08.29,Default,,0000,0000,0000,,Before starting the myomectomy procedure, the
Dialogue: 0,0:00:08.29,0:00:11.52,Default,,0000,0000,0000,,surgeon has to pull up the bowel
Dialogue: 0,0:00:11.52,0:00:15.63,Default,,0000,0000,0000,,with the sterile pack
Dialogue: 0,0:00:15.63,0:00:19.33,Default,,0000,0000,0000,,so that the bowel will be retracted upwards
Dialogue: 0,0:00:19.33,0:00:25.40,Default,,0000,0000,0000,,and to facilitate proper and easier visualization
Dialogue: 0,0:00:25.40,0:00:26.75,Default,,0000,0000,0000,,of the surgical field.
Dialogue: 0,0:00:26.75,0:00:33.38,Default,,0000,0000,0000,,After proper preparation of retraction of the bowel and
Dialogue: 0,0:00:33.38,0:00:41.02,Default,,0000,0000,0000,,then insertion of the retractor to widen the surgical field
Dialogue: 0,0:00:41.02,0:00:42.60,Default,,0000,0000,0000,,
Dialogue: 0,0:00:42.60,0:00:48.83,Default,,0000,0000,0000,,then the next step is to apply tonically?
Dialogue: 0,0:00:48.83,0:00:54.43,Default,,0000,0000,0000,,because the most important step in a myomectomy is to conduct the surgery with
Dialogue: 0,0:00:54.43,0:00:56.43,Default,,0000,0000,0000,,less blood loss
Dialogue: 0,0:00:56.43,0:01:01.67,Default,,0000,0000,0000,,thus, hemostatis or decreasing hemhorrage is a very important step in myomectomy
Dialogue: 0,0:01:01.67,0:01:05.37,Default,,0000,0000,0000,,because myomectomy is going to be a blind x unless you
Dialogue: 0,0:01:05.37,0:01:09.78,Default,,0000,0000,0000,,conduct in a way which decrease blood loss
Dialogue: 0,0:01:09.78,0:01:12.31,Default,,0000,0000,0000,,the interoperative blood loss might be very high.
Dialogue: 0,0:01:12.31,0:01:18.81,Default,,0000,0000,0000,,There are different techniques but the common method which we use is to apply
Dialogue: 0,0:01:18.81,0:01:24.23,Default,,0000,0000,0000,,tonicity, which is to use a #8 catheter.
Dialogue: 0,0:01:24.23,0:01:25.90,Default,,0000,0000,0000,,So we open a window on both sides of
Dialogue: 0,0:01:25.90,0:01:28.37,Default,,0000,0000,0000,,lateral aspect of the utuerus, then tightly
Dialogue: 0,0:01:28.37,0:01:38.04,Default,,0000,0000,0000,,close it or suture it, or wrapping the catheter
Dialogue: 0,0:01:38.04,0:01:41.26,Default,,0000,0000,0000,,so that catheter is going to occlude the
Dialogue: 0,0:01:41.26,0:01:47.26,Default,,0000,0000,0000,,the uterine arteries on both sides and then decrease the blood flow to the upper part of the uterus
Dialogue: 0,0:01:47.26,0:01:49.10,Default,,0000,0000,0000,,thereby decrease the blood loss.
Dialogue: 0,0:01:49.10,0:01:53.27,Default,,0000,0000,0000,,So after applying a tonicy on the lower aspect of the utuerus
Dialogue: 0,0:01:53.27,0:01:58.93,Default,,0000,0000,0000,,sometimes, depending on the need, the size of the myoma, the tonicy ?
Dialogue: 0,0:01:58.93,0:02:02.57,Default,,0000,0000,0000,,also on the ovarian vessels might be needed
Dialogue: 0,0:02:02.57,0:02:07.29,Default,,0000,0000,0000,,but usually tonicy applied on the uterine vessels is usually sufficient
Dialogue: 0,0:02:07.29,0:02:12.91,Default,,0000,0000,0000,,Currently one can apply or inject a vassopressin
Dialogue: 0,0:02:12.91,0:02:19.62,Default,,0000,0000,0000,,which is a kind of drug which will decrease the blood loss to the myoma
Dialogue: 0,0:02:19.62,0:02:23.62,Default,,0000,0000,0000,,and then you can conduct the surgery.