Myomectomy — 12-minute structured oral station

FRANZCOG oral-format station on myomectomy: structured consent, the FIGO type-to-route decision rule, the morcellation discussion (RANZCOG C-Gyn 33, FDA 2014, occult sarcoma risk per Kho 2016), the vasopressin and tourniquet haemostasis strategy, the multi-layer closure with barbed suture (2024 meta-analysis), contained in-bag specimen extraction, and the consent on recurrence, uterine rupture and future pregnancy. Scored against the eight published RANZCOG oral domains.

Prompt

You are the gynaecology registrar in the outpatient clinic. A 34-year-old nulliparous woman with a 9-week-size uterus, a dominant 7 cm posterior intramural fibroid (FIGO type 4), and a 2 cm submucous fibroid (FIGO type 1) presents with heavy menstrual bleeding and anaemia (Hb 95 g/L). She wishes to preserve her fertility, has read about 'morcellation' online and asks whether laparoscopic myomectomy is safe. The examiner will ask you to plan the workup, defend your surgical strategy, and walk through the morcellation consent and the technique step by step.

Myomectomy — 12-minute structured oral station

Station format

4 minutes reading, 12 minutes examination, 20 marks, global scoring. The eight published RANZCOG oral domains apply to every station: history and examination; investigations and interpreting results; treatment and management; clinical knowledge; complex, urgent or unusual clinical presentations; rapport with patient, support person or colleague; respect; communication skills. You are being marked on how you behave, not only what you know.

References6Show

[1]Kathopoulis N, Prodromidou A, Douligeris A, Diakosavvas M, Zacharakis D, Kypriotis K, Chatzipapas I, Grigoriadis T, Protopapas A Barbed Sutures Compared With Conventional Sutures During Laparoscopic Myomectomy: A Systematic Review and Meta-analysis Obstet Gynecol, 2024.PMID 39146537
[2]Devassy R, Devassy RR, de Wilde MS, Krentel H, Adlan A, Torres-de la Roche LA, De Wilde RL The Future of Minimal-Access Myoma Surgery with In-Bag Contained Morcellation J Clin Med, 2023.PMID 37297823
[3]Balachandran A, Mishra RK, Effie AO, Raghunathan A, Mathew A, Archana S A systematic review and meta-analysis of efficacy of vasopressin as a vasoconstrictive and uterotonic drug in laparoscopic myomectomy J Minim Access Surg, 2024.PMID 39724600
[4]Kho KA, Lin K, Hechanova M, Richardson DL Risk of Occult Uterine Sarcoma in Women Undergoing Hysterectomy for Benign Indications Obstet Gynecol, 2016.PMID 26855091
[5]Clark NM, Schembri M, Jacoby VL Change in Surgical Practice for Women With Leiomyomas After the U.S. Food and Drug Administration Morcellator Safety Communication Obstet Gynecol, 2017.PMID 29016511
[6]Ahmad G, Kim K, Thompson M, Agarwal P, O'Flynn H, Hindocha A, Watson A Barrier agents for adhesion prevention after gynaecological surgery Cochrane Database Syst Rev, 2020.PMID 32199406

Station format

References6Show

[1]Kathopoulis N, Prodromidou A, Douligeris A, Diakosavvas M, Zacharakis D, Kypriotis K, Chatzipapas I, Grigoriadis T, Protopapas A Barbed Sutures Compared With Conventional Sutures During Laparoscopic Myomectomy: A Systematic Review and Meta-analysis Obstet Gynecol, 2024.PMID 39146537
[2]Devassy R, Devassy RR, de Wilde MS, Krentel H, Adlan A, Torres-de la Roche LA, De Wilde RL The Future of Minimal-Access Myoma Surgery with In-Bag Contained Morcellation J Clin Med, 2023.PMID 37297823
[3]Balachandran A, Mishra RK, Effie AO, Raghunathan A, Mathew A, Archana S A systematic review and meta-analysis of efficacy of vasopressin as a vasoconstrictive and uterotonic drug in laparoscopic myomectomy J Minim Access Surg, 2024.PMID 39724600
[4]Kho KA, Lin K, Hechanova M, Richardson DL Risk of Occult Uterine Sarcoma in Women Undergoing Hysterectomy for Benign Indications Obstet Gynecol, 2016.PMID 26855091
[5]Clark NM, Schembri M, Jacoby VL Change in Surgical Practice for Women With Leiomyomas After the U.S. Food and Drug Administration Morcellator Safety Communication Obstet Gynecol, 2017.PMID 29016511
[6]Ahmad G, Kim K, Thompson M, Agarwal P, O'Flynn H, Hindocha A, Watson A Barrier agents for adhesion prevention after gynaecological surgery Cochrane Database Syst Rev, 2020.PMID 32199406