Successful Application of Manual Hand Morcellation Technique in Giant Leiomyoma: A Case Report

Abstract

Introduction: Uterine leiomyoma is the most common benign neoplasm of the female reproductive tract. However, he use of the laparoscopy approach for giant myomas is still controversial and rarely performed. Only few cases have been published in the literature. Retrieval of giant myoma in laparoscopy is difficult and still challenging even by a power morcellator.
 Case presentation: A 39 years old para 3 woman was referred to the gynaecology department with abdominal swelling during the previous 3 years. No family history, past medical and gynaecology history disease was reported. A physical examination revealed a firm huge palpable abdominal mass with identifiable borders. The mass extended to her umbilicus. The abdominal ultrasound revealed a markedly enlarged and lobular uterus containing intramural uterine leiomyoma measuring 15 x14 cm without ascites. No additional pathology was noted. The results of the laboratory examination were within normal limit. She was offered laparoscopy removal of myoma.
 Conclusion: The case concludes the efficiency, reliability, and safety of laparoscopy surgery to treat huge leiomyoma and try to consider manual hand morcellation to remove the entire myoma to reduce spreading malignancy through electrical morcellation. Although a laparoscopic approach for a huge myoma has several challenges, it does represent an option for minimally invasive removal of giant myoma.
 Keywords: Giant leiomyoma, Laparoscopy, Leiomyoma, Morcellation, Manual morcellation