Laparoscopic Myomectomy in the 2nd Trimester of Pregnancy

Abstract

Video Objective The purpose of this video is to demonstrate surgical management of a symptomatic fibroid in the 2nd trimester of pregnancy. Setting This patient is a 26 year old G1P0 who presented to a tertiary care centre at 18 weeks and 3 days gestational age with severe abdominal pain. This was her third presentation to hospital for abdominal pain during pregnancy. She was given intravenous and oral narcotics, which did not alleviate her pain. She was otherwise healthy, with no previous surgeries. This pregnancy was a spontaneous conception. She was incidentally diagnosed with a fibroid at approximately 7 weeks gestational age on her dating ultrasound. On presentation, she was uncomfortable at rest, with stable vitals. Her abdomen was soft, with involuntary guarding. She had severe pain on light palpation of her right lower quadrant. An MRI of her abdomen and pelvis delineated this to be a pedunculated fundal uterine fibroid, measuring 19.4 by 13.2 by 16.2cm, retroplacental in location. Her pregnancy has otherwise been uncomplicated, with a normal enhanced first trimester screen and normal anatomy ultrasound. She continued to experience episodes of refractory severe pain. Ultimately, she was consented for a laparoscopic myomectomy, with mini-laparotomy and morcellation. Interventions Laparoscopic myomectomy, with mini-laparotomy and morcellation of the fibroid at 18 weeks and 5 days gestational age. Conclusion This case is an example of safe antenatal surgical management for symptomatic fibroids in patients who fail conservative medical management. Antenatal surgical management has generally been recommended against due to the risk of pregnancy loss. With proper patient selection, a myomectomy can be safely done in the antenatal period for patients who fail conservative medical management.