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Photograph of a uterus with multiple large fibroids that are predominantly subserosal in location but also do extend partially into the wall of the uterus (have a transmural component). The larger fibroid adjacent to the right fallopian tube is being probed with the irrigator aspirator instrument in the pelvis to attempt to outline the depth of its invasion into the uterine wall. Preoperative ultrasonography suggested only minimal invasion into the uterine wall. A major concern in considering removal of this particular myoma is the possibility of extension into the right broad ligament that underlies the right fallopian tube and right ovary. The broad ligament contains many major blood vessels, nerves and the ureter (that carries urine from the kidney to the bladder). In this case, I was able to outline the lateral extent of the myoma with the blunt probe and I was able to determine that I could safely remove the tumor (fibroid).
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