Laparoscopic Myomectomy of Vaginal Leiomyoma: A Video Case Report

Abstract

<h3>Study Objective</h3> To demonstrate the surgical steps of a laparoscopic excision of a vaginal leiomyoma. <h3>Design</h3> We present a video of laparoscopic excision of a vaginal myoma. <h3>Setting</h3> Private hospital in Curitiba, Paraná, Brazil. <h3>Patients or Participants</h3> A 45 years-old woman, G2 P2, was referred to our outpatient clinic with a complaint of abdominal pain, frequent urination and nocturia over five months. She underwent vaginal hysterectomy one year earlier due to uterine myoma. On digital examination a round and firm mass was palpable in the left vaginal wall. Magnetic resonance imaging of abdomen and pelvis reported a solid tumor in the left side of vaginal fornix measuring 28 × 26 mm, located 2mm from ureter. The patient underwent a laparoscopic excision of the vaginal tumor. The post-operative histopathology confirmed leiomyoma. <h3>Interventions</h3> A laparoscopic myomectomy was recorded and presented in the video. <h3>Measurements and Main Results</h3> We described the main steps of laparoscopic myomectomy of vaginal leiomyoma. Step 1: Exposure of the operation field. Step 2: Incision and dissection with ultrasonic instrument of visceral peritoneum over the vaginal fornix and towards the rectovaginal space. Step 3: Vaginal opening and excision. Step 4: Dissection towards the leiomyoma to reach the cleavage plane. Step 5: Grasping and traction of the leiomyoma with a traumatic forceps to its enucleation and excision. Step 6: Extraction of leiomyoma through the vagina. Step 7: Vaginal closure with intracorporeal suturing in two layers: first with continuous suture, followed by a second layer with three X stitches of zero poliglecaprone 25. Step 8: Bipolar hemostasis. <h3>Conclusion</h3> The laparoscopic myomectomy of vaginal leiomyoma presented can be an effective and safe treatment due to the advantages of minimally invasive surgery. Our patient was previously hysterectomized, but laparoscopy is a prudent approach as well when necessary to undergo myomectomy of vaginal and uterine fibroids concomitantly.