14: Cervical myomectomy: a minimally-invasive approach

Abstract

To illustrate the use of robotic-assisted laparoscopy in the removal of a large cervical myoma. Uterine leiomyomas affect 70-80% of reproductive aged women and cervical myomas account for less than 5% of uterine myomas. Symptoms of cervical myomas include pelvic pain, bulk symptoms, dyspareunia, abnormal bleeding or discharge, and diminished fertility. Surgical removal of cervical myomas may be indicated to relieve symptoms and preserve fertility. Cervical myomectomies are challenging due to difficult surgical dissection through the cervical stroma as well as proximity to the cervical canal and other vital pelvic structures including bowel, bladder, uterine vessels, and ureter. In this video, we illustrate the key surgical steps of robotic-assisted laparoscopic cervical myomectomy and highlight some of the surgical challenges. Key surgical steps include:1.Identify pathology and key anatomy.2.Infiltrate myometrium with dilute vasopressin.3.Strategic hysterotomy.4.Identification and careful dissection of anatomic plans.5.Tenaculum for traction/countertraction.6.Closure.7.Manual and contained tissue extraction. A minimally invasive surgical approach is a feasible option in a patient with a markedly enlarged cervical myoma.