Laparoscopic Myomectomy Followed by Minilaparotomy for Management of a Large Submucous Fibroid

Abstract

Background: We describe a patient with a single large type II submucous fibroid distorting and occupying the entire endometrial cavity, which was managed successfully with an approach less invasive than laparotomy. Case: The patient was a 36-year-old woman who presented with primary infertility of 2 years duration. Her associated complaints were menorrhagia and known uterine fibroids. She had undergone hysteroscopic myomectomy in the past without any improvement. An hysterosalpingogram revealed that the uterine cavity was occupied by a single large submucosal fibroid. Transvaginal ultrasound and saline infusion hysterosonogram showed a large anterior type II submucous, intramural, subserous fibroid. Diagnostic hysteroscopy and laparoscopy revealed a type II submucous fibroid occupying the entire anterior wall of the uterus. Laparoscopic myomectomy was performed and a fibroid measuring 8 cm was dissected. During the process, the endometrial cavity was entered and a minilaparotomy via a 5-cm transverse skin incision was performed to repair the endometrial cavity and overlying myometrium adequately and to remove the myoma. Results: Her postoperative course was uneventful. Six weeks later, saline infusion hysterosonogram revealed a uniform endometrial cavity with no filling defects or synechiae. Conclusions: Laparoscopic myomectomy with minilaparotomy is a safe, cost-effective, and less invasive approach for the treatment of patients with large type II submucous fibroids who want to preserve their reproductive potential. (J GYNECOL SURG 29:161)