Laparoscopic Myomectomy of Large Broad Ligament Fibroid

Abstract

<h3>Study Objective</h3> To demonstrate surgical techniques aimed at successfully navigating the anatomic distortion caused by large broad ligament fibroids. <h3>Design</h3> N/A. <h3>Setting</h3> The patient underwent surgery at a tertiary care center. They were placed in dorsal lithotomy position in steep Trendelenburg to aid in performance of pelvic laparoscopy. Insufflation was carried out to 15mmHg. A primary 10mm umbilical trocar was used for the camera and three additional 5mm assist ports were placed. <h3>Patients or Participants</h3> 36-year-old G1P0 who presented with pelvic pressure, dyspareunia, and bowel/bladder dysfunction. Evaluation revealed a 9cm left broad ligament fibroid. The patient desired future fertility and elected to undergo laparoscopic myomectomy. <h3>Interventions</h3> Laparoscopic myomectomy, temporary ligation of ipsilateral uterine artery at the origin. <h3>Measurements and Main Results</h3> Successful fibroid removal with minimal blood loss and no intra-operative complications. Patient had same-day discharge followed by uneventful post-operative recovery. <h3>Conclusion</h3> Large broad ligament fibroids present many surgical challenges due to proximity to and compression of vital retroperitoneal structures, but laparoscopic myomectomy can be safely and efficiently performed using the reproducible techniques outlined in this video.