Approach to Total Laparoscopic Hysterectomy Involving Large Cervical Myomas

Abstract

<h3>Study Objective</h3> To review the literature regarding cervical myomas and present surgical videos from two cases of patients who underwent total laparoscopic hysterectomy for large cervical myomas, reviewing surgical techniques and key steps in approaching total laparoscopic hysterectomy with large anatomy distorting cervical myomas in two different locations. <h3>Design</h3> Two case reports with surgical videos. <h3>Setting</h3> Tertiary care hospital. <h3>Patients or Participants</h3> Two patients. <h3>Interventions</h3> Patient 1 was a 48 y/o G2P0 with a history of myomas presenting with pelvic pain and heavy menstrual bleeding that had been worsening. Ultrasound demonstrated a 6 cm right anterior cervical myoma and patient underwent total laparoscopic hysterectomy for management. Patient 2 was a 52 y/o G5P3 with a history of myomas presenting with heavy menstrual bleeding. Ultrasound demonstrated a 9.7 cm posterior cervical myoma and patient underwent total laparoscopic hysterectomy for management. In both cases, hysterectomy was accomplished laparoscopically by ligating uterine arteries at their origin in the pelvic side wall to control blood supply, enucleating the myomas to restore more normal anatomy, and using colpotomy cup to help identify cervical edges. <h3>Measurements and Main Results</h3> Both hysterectomies were completed laparoscopically with minimal blood loss, no complications, and complete removal of cervix despite anatomical distortion. Surgical techniques are reviewed in the surgical video. <h3>Conclusion</h3> Large cervical myomas can significantly distort anatomy, posing surgical challenges, but laparoscopic hysterectomy is still feasible by securing the blood supply to the uterus and restoring normal anatomy with familiarity of pelvic spaces and care dissection of surrounding vital structures.