{"paper_id":"68ced1fb-cf0c-4828-9cbd-033f453e8b22","body_text":"Abstract\nThe challenges while operating in cases of endometriosis and cervical and broad ligament leiomyomas are the fact that the lesion can be very close to the ureter. There could be ureteric compression and hydroureter in long-standing cases. In addition, endometriosis is known to involve the bowel. The condition might require uretric reimplantation if the ureters are involved. Resection anastomosis of the involved segment may be required if the disease involves the bowel. The urological component of the surgery has to be done with a urologist, and bowel resection and anastomosis have to be done with a surgeon. The fundamental principles of operating in such cases are use of sharp dissection and locating the ureter early in the course of dissection in order to avoid ureteric injuries. One must try to excise all the endometriotic tissues in order to avoid recurrence. In case of leiomyomas, one must try and avoid morcellation of the specimen if the leiomyoma is very large, soft, and fleshy and appears on gross examination like a sarcoma. Before considering myomectomy for improving fertility, options like IVF and surrogacy must be discussed since successful removal of leiomyomas and conception are two different issues. During myomectomy for improving fertility, the leiomyoma(s) must be removed without incising the uterine cavity or must be removed through a single incision in the uterine cavity. The risks of preterm labor, uterine rupture, placenta previa, and placenta accreta are high if the uterine cavity is opened during myomectomy.\nThis section is written mainly considering destructive surgeries in mind, that is, hysterectomy and salpingo-oophorectomy.\nAccess this chapter\nTax calculation will be finalised at checkout\nPurchases are for personal use only\nSimilar content being viewed by others\nReferences\nRakotomahenina H, Rajaonarison J, Wong L, Brun JL. Myomectomy: technique and current indications. Minerva Ginecol. 2017;69(4):357–69.\nKim HS, et al. Uterine rupture in pregnancies following myomectomy: a multicenter case series. Obstet Gynecol Sci. 2016;59(6):454–62.\nMohling SI, Elkattah R, Furr RS. Endometriosis: tools for the frozen pelvis. J Minim Invasive Gynecol. 2015;22(6):S139.\nDe La Hera-Lazara, et al. Radical surgery for endometriosis: analysis of quality of life and surgical procedure. Clin Med Insights Women’s Health. 2016;9:7–11.\nStegmann BJ, et al. Using location, color, size, and depth to characterize and identify endometriosis lesions in a cohort of 133 women. Fertil Steril. 2008;89(6):1632–6.\nLlewellyn-Bennett, et al. Iatrogenic endometriosis of the vaginal vault following a total laparoscopic hysterectomy. West Lond Med J. 2010;2(4):1–4.\nEngelsgjerd JS, LaGrange CA. Ureteral injury. Treasure Island, FL: StatPearls Publishing; 2018. Last Update: October 27.\nBurks FN, Santucci RA. Management of iatrogenic ureteral injury. Ther Adv Urol. 2014;6(3):115–24.\nEl-Khalfaoui K, Bois A, Heitz, Kurzeder C, Sehouli J, Harter P. Current and future options in the management and treatment of uterine sarcoma. Ther Adv Med Oncol. 2014;6(1):21–8.\nLiu H, Zhu Y, Zhang G, Wang C, Li C, Shi Y. Laparoscopic surgery on broken points for uterine sarcoma in the early stage decrease prognosis. Sci Rep. 2016;6:31229.\nTrimble CL, et al. Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia: a gynecologic oncology group study. Cancer. 2006;106:812–9.\nAuthor information\nAuthors and Affiliations\nRights and permissions\nCopyright information\n© 2020 Springer Nature Singapore Pte Ltd.\nAbout this chapter\nCite this chapter\nPodder, A.R., Seshadri, J.G. (2020). Endometriosis, Cervical and Broad Ligament Leiomyomas: How to Avoid Injuries. In: Atlas of Difficult Gynecological Surgery. Springer, Singapore. https://doi.org/10.1007/978-981-13-8173-7_7\nDownload citation\nDOI: https://doi.org/10.1007/978-981-13-8173-7_7\nPublished:\nPublisher Name: Springer, Singapore\nPrint ISBN: 978-981-13-8172-0\nOnline ISBN: 978-981-13-8173-7\neBook Packages: MedicineMedicine (R0)","source_license":"CC0","license_restricted":false}