2564 Vagina Fibroid: A Laparoscopic Approach

Abstract

Video Objective To demonstrate a minimally invasive technique used on approaching of a large vaginal fibroid. Setting A 30-year-old woman with important transvaginal bleeding which started 6 months ago. A MRI was perfomed and showed the presence of an heterogeneous image with slightly lobed contours, located on the upper third of the right vaginal wall, measuring 6,4 × 6,4 × 5,9cm, subsequentaly. Interventions The patient was admitted to a terciary hospital of the Fortaleza - Brazil (Cesar Cals Hospital) for a video- assisted vaginal myomectomy due to a large vaginal fibroid as described by a previous MRI. Intraoperatively, with the aid of a laparoscopy was verified that the fibroid extended deep into the pararectal and parametrial spaces, being necessary to approach this spaces to identify noble structures, such as ureter and pelvic nerves. Surgical procedure was successfully completed and the patient was discharged on the day after surgery. Conclusion Vaginal fibroids are a rare condition and commonly need a vaginal approach surgery. However, in some cases it requires both abdominal and vaginal approach when de fibroids are so extensive and infiltrative. This video uses a particularly challenging case to demonstrate a laparoscopic assisted vaginal myomectomy as a safe procedure for cases like this. To demonstrate a minimally invasive technique used on approaching of a large vaginal fibroid. A 30-year-old woman with important transvaginal bleeding which started 6 months ago. A MRI was perfomed and showed the presence of an heterogeneous image with slightly lobed contours, located on the upper third of the right vaginal wall, measuring 6,4 × 6,4 × 5,9cm, subsequentaly. The patient was admitted to a terciary hospital of the Fortaleza - Brazil (Cesar Cals Hospital) for a video- assisted vaginal myomectomy due to a large vaginal fibroid as described by a previous MRI. Intraoperatively, with the aid of a laparoscopy was verified that the fibroid extended deep into the pararectal and parametrial spaces, being necessary to approach this spaces to identify noble structures, such as ureter and pelvic nerves. Surgical procedure was successfully completed and the patient was discharged on the day after surgery. Vaginal fibroids are a rare condition and commonly need a vaginal approach surgery. However, in some cases it requires both abdominal and vaginal approach when de fibroids are so extensive and infiltrative. This video uses a particularly challenging case to demonstrate a laparoscopic assisted vaginal myomectomy as a safe procedure for cases like this.