1892 Laparoscopic Removal of Large Submucous Myomas

Abstract

Video Objective This video demonstrates the laparoscopic approach in the management of large submucous myomas and minimal damage on the endometrium. Setting The patient is a 45 year old, G2 P2 woman with the complaint of heavy menstrual bleeding. Ultrasonography revealed a 5 × 4 cm submucous myoma with 10-20 % of intramural extension. Interventions Following serosal incision with bipolar energy instrument and entering the endometrial cavity, submucous myoma is extracted, the endometrial defect is closed submucosally with 2-0 V - lock suture. Myometrial defect is closed in double layer closure. Integrity of the endometrial cavity and the sutured line are assessed by an office hysteroscopy at the end of the procedure. Conclusion Given the fact that the complication risks increase with size and intramyometrial extension of submucous myomas during hysteroscopic surgery; laparoscopic myomectomy may be a better treatment option especially for patients with submucous fibroids more than 4 cm in size and/or with an intrauterine extension of more than 50%. A concomitant control hysteroscopy thereafter is useful to identify if the endometrial cavity remains intact after the procedure.