Laparoscopic Myomectomy: Surgical Tips and Tricks

Abstract

<h3>Study Objective</h3> The objective of this video is to provide surgical and suturing tips for successful laparoscopic myomectomy of an enlarged fibroid uterus. <h3>Design</h3> Video case presentation. <h3>Setting</h3> The surgery in this video was performed in the operating room at an academic medical center. The patient was positioned in dorsal lithotomy position. Laparoscopic myomectomy and closure were completed using a 12mm umbilical port, a 12mm left lower quadrant port, a 5mm left upper quadrant port, and a 5mm right lower quadrant port. <h3>Patients or Participants</h3> The patient is a 38-yo G0 with symptomatic uterine fibroids including heavy menstrual bleeding and bulk symptoms, desiring future fertility. She had a preoperative pelvic MRI demonstrating a 15cm multifibroid uterus with 6 fibroids, the largest being a 7.5cm Type II-V fibroid at the uterine fundus. She's had a prior laparoscopic right salpingo-oophorectomy for an ovarian stromal tumor and reports that 2 small fibroids were also removed at that time. <h3>Interventions</h3> Laparoscopic enterolysis, laparoscopic myomectomy <h3>Measurements and Main Results</h3> This patient underwent an uncomplicated laparoscopic myomectomy. Total operative time was 201 minutes. Estimated blood loss was 100cc. Eight fibroids were removed, weighing 459g. The endometrial cavity was entered, and she will need a cesarean section with future deliveries. The patient was doing well at her 2-week post-operative visit with improvement in pelvic pain and bleeding. She will have an in-office flexible hysteroscopy 3 months post-op during the early proliferative phase prior to pursuing fertility goals. <h3>Conclusion</h3> Laparoscopic myomectomy of a large fibroid uterus can be successfully completed with minimal blood loss using the techniques described in this video. Closure of deep myometrial and endometrial defects can be done under good visualization utilizing ipsilateral ports for efficient suture placement and recovery.