Phone: 305-596-3744

Fax: 305-596-3676

www.drwhitted.net

Raymond Wayne Whitted MD, MPH

...dedicated to healthy lifestyles and safe, state-of-the-art surgery for

women of all ages.

R. Wayne Whitted MD, MPH

8740 North Kendall Drive

Suite 101

Miami, Florida 33176-2212

UTERINE “FIBROIDS”

Fibroids (leiomyoma) are muscle

growths in the Uterus that affect

30%-40% of women. They usu-

ally are asymptomatic and can be

left alone and rarely are malignant. Fibroids may

require treatment for the following reasons:

 Pain (usually cramping and lower pelvic area)

 Bleeding (abnormal)

 Urinary frequency and bladder pressure

(usually secondary to size of uterus)

 Rapid growth

Fibroids are classified by location. Intra-cavitary

ones are in the uterine lining, intramural are in the

muscle of the uterus, and serosal are on the out-

side of the uterus. Submucosal fibroids are

partly in the lining and muscle. Pedunculated

ones are on the outside of the uterus dangling from

a stalk.

Fibroids are initially diagnosed through pelvic exam

and ultrasound. Office hysteroscopy or saline infu-

sion sonography define intracavitary and submuco-

sal ones. Occasionally an MRI is performed to lo-

cate each individual fibroid within the uterus. This

is especially important in certain types of fibroids if

the hysteroscopic or laparoscopic surgery is con-

sidered.

Dr. Whitted is dedicated to safe, state-of-the-art,

innovative surgeries and healthy lifestyles for

women of all ages. In a nurturing environment,

the physicians and staff strive to promote a part-

nership in your healthcare and make every effort

to bridge the sterile science of diseases with your

emotional, physical, and spiritual needs. Every-

one is confronted with difficult healthcare deci-

sions at one time or another. You’ll want your

physician and staff to have the knowledge, experi-

ence, and sensitivity to guide you safely through

the decision-making process.

Dr. Whitted provides comprehensive gynecologic

office and surgical healthcare. He is certified in

laparoscopy and hysteroscopy and is an expert in

advanced gynecologic surgery. He has been a

national speaker, trainer, and researcher in ad-

vanced surgical techniques. In addition, Doctor

Whitted is a Certified Menopause Clinician who

educates, trains, and has done research in the

science of menopause. Finally, he is certified in

advanced colposcopy.

Doctor Whitted offers expert education and care in

the following areas:

If you need surgery, Dr. Whitted usually performs

minimally invasive surgery (Vaginal, laparoscopy

and hysteroscopy) and has many years experi-

ence in these areas.

Abnormal Paps (HPV) Loss of Urine

Abnormal Menstrual Cycles Menopause

Bladder Prolapse Ovarian cysts

Chronic Pelvic Pain Osteoporosis

Endometriosis Rectocele

Ectopic Pregnancy Uterine Prolapse

Family Planning Vaginal Prolapse

Fibroids (Leiomyoma) Well-Woman visit

***Evaluation and Diagnosis of Gynecologic Cancers

...

dedicated to healthy lifestyles and safe, state-of-the-art, innovative surgery for women of all ages

Hysteroscopic Myomectomy

Laparoscopic Myomectomy Abdominal Myomectomy

If you and your Doctor decide surgery is your best

choice for the management of your fibroids you

will need to understand the 3 approaches to non-

hysterectomy surgical fibroid management.

These are Hysteroscopy, Laparoscopy, and/or

Laparotomy (abdominal incision) approaches..

During Hysteroscopy a telescope is inserted in-

side the uterus through the vagina. No incisions

are used. Distending fluid medium allows for visu-

alization of the intra-uterine abnormalities. Instru-

ments are inserted through the hysteroscope so

that specific abnormalities can be removed. Com-

mon gynecologic problems that can be addressed

with the hysteroscope include:

 Removal of Fibroids and Polyps

 Endometrial Sampling

 Endometrial Ablation (destruction of the endo-

metrial lining)

 Adhesiolysis

 Septolysis

 Fallopian tube cannulization

 Removal of an IUD (intra-uterine contracep-

tive device)

The risks associated with hysteroscopy include

bleeding, infection, perforation, injuring abdominal

organs, fluid overload, inability to complete the

procedure, failure to correct the symptoms, and air

emboli.

Hysteroscopy is usually an outpatient surgery and

has minimal postoperative recovery associated

with it.

Laparoscopic Myomectomy is chosen based on

feasibility. It is performed like abdomoinal myo-

mectomy only through minimal incisions on the

abdomen. It is most feasible when there are no

more than 3 fibroids, the largest one measuring no

more than 10cm, and none in the extremely ante-

rior or posterior position. Finally, special surgical

skill is required to perform laparoscopic myomec-

tomy.

When laparoscopic myomectomy is chosen a

“telescope” is placed through the “belly button”

after an incision is made. 3 other small incisions

are made based on the locations of the “fibroids”.

These are usually in the right and left lower quad-

rants and in the suprapubic area.

Once the trocars are placed, instruments are in-

serted through the trocars and the operation is

performed. An injection of diluted pitressin (a he-

mostatic agent) is made in the capsule of the fi-

broid. Once blanching is seen an incision is made

through the capsule identifying the fibroid. It is

then shelled out of its “bed”. The defect in the

uterus is then closed with sutures. The fibroid is

then brought out through one of the trocar sites by

morcellating (cutting into pieces) it. The tissue is

sent for pathologic evaluation.

The risks associated with any myomectomy are

bleeding, infection, injury to abdominal organs,

possible need for cesarean section, possible hys-

terectomy, fibroid recurrence (30%), endometrio-

sis, adenomyosis,

Laparoscopic myomectomy is usually an outpa-

tient surgery and has minimal postoperative re-

covery associated with it.

Abdominal Myomectomy is chosen when the mini-

mally invasive approaches are not feasible. This

method requires a large incision on the abdomen.

The incision can be a “bikini” cut or may need to

be a vertical one (from pubic bone to “belly but-

ton”) depending on the sizes and locations of the

fibroids.

Abdominal myomectomy can have significant

blood loss because the uterus is a very vascular

organ. To minimize this we utilize a tourniquet to

reduce the vascular supply. In addition we inject

the fibroid with a diluted solution of Pitressin (a

vasoconstrictive agent).

The risks associated with abdominal myomectomy

include bleeding, infection, injury to abdominal

organs, possible need for cesarean section, possi-

ble hysterectomy, fibroid recurrence (30%), endo-

metirosis, adenomyosis.

Abdominal myomectomy usually requires a 1 or 2

day hospital stay and requires 3-6 weeks recov-

ery.

Fibroid Location

Fibroid Removal Incision closure

Capsule incision