Abstract
<h3>Study Objective</h3> To demonstrate surgical techniques aimed at successfully navigating the anatomic distortion caused by cervical fibroids during hysterectomy. <h3>Design</h3> N/A. <h3>Setting</h3> The patient was 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 assist ports were placed. <h3>Patients or Participants</h3> The patient is a 37-year-old G1P1001 who presented with heavy bleeding and cramping. Work-up revealed a 6cm cervical fibroid. The patient did not desire future fertility and elected to undergo laparoscopic hysterectomy. The patient was given three months of a GnRH agonist to control bleeding and improve pre-operative hemoglobin. <h3>Interventions</h3> Total laparoscopic hysterectomy with bilateral ligation of the uterine artery at its origin from the hypogastric artery, bilateral salpingectomy, bilateral ureterolysis, cystoscopy with placement of ureteral stents. <h3>Measurements and Main Results</h3> Uncomplicated surgery with same-day discharge followed by uneventful post-operative recovery. <h3>Conclusion</h3> Large cervical fibroids present many surgical challenges, but laparoscopic hysterectomy can be safely and efficiently performed using the reproducible techniques outlined in this video.
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