Laparoscopic Myomectomy in the Retzius Space

Abstract

<h3>Study Objective</h3> To illustrate a laparoscopic approach for the excision of the rare fibroid found within the Retzius space, to showcase relevant anatomy of the paravesical and Retzius space as well as to review the retroperitoneal vascular anatomy of the female pelvis. <h3>Design</h3> Elective Laparoscopic Myomectomy. <h3>Setting</h3> After verification of informed consent, the patient was taken to the operating room where a safety surgical briefing was performed. The patient was given a general anesthetic. They were then prepped and draped in the dorsal lithotomy position. 2g of Ancef was given. A foley catheter was inserted under sterile conditions and a Mengeshkar uterine manipulator was placed. <h3>Patients or Participants</h3> Previously healthy 36-year-old G1P1 who presented with a growing abdominal mass, she was otherwise asymptomatic. She was consented for laparoscopic myomectomy and underwent GnRH agonist treatment for 3 months prior to surgery. <h3>Interventions</h3> Laparoscopic Surgery. <h3>Measurements and Main Results</h3> Estimated blood loss was 400cc. The patient had no postoperative complications and was discharged home on post-operative day 1. The final specimen pathology was leiomyoma with a specimen weight of 556g. <h3>Conclusion</h3> Leiomyomas within the Retzius space are rare and can be safely excised using a laparoscopic approach. Bladder insufflation along with recognition of pelvic anatomical landmarks optimizes surgical navigation. Awareness of vascular structures present within Retzius space is instrumental for safe dissection.