Surgical Pearls for Laparoscopic Resection of a Cervical Leiomyoma

Abstract

Study Objective To describe and demonstrate surgical pearls for complete laparoscopic excision of a cervical leiomyoma. Design Video presentation of a clinical case with imaging, surgical procedure, and key teaching points. Setting Academic Institution. Patients or Participants 33-year old G0 woman with a 4 year history of infertility and abnormal uterine bleeding refractory to hormonal agents. Interventions The patient underwent a diagnostic hysteroscopy, laparoscopic myomectomy, and chromopertubation. Measurements and Main Results Surgical recommendations for safe and effective laparoscopic resection of cervical myomas include dissection of the bladder using a lateral to medial approach, backfilling of the bladder when necessary to avoid injury, and taking care to avoid entry into the cervical canal while achieving complete excision. A pediatric Foley catheter can function as stent to post-operative cervical stenosis. Additional techniques for hemostasis in this type of complex surgery are also reviewed. Retroperitoneal isolation of the uterine arteries and the use of laparoscopic bulldog clamps may be necessary for larger myomas. Conclusion Complete laparoscopic resection of cervical myomas can be performed safely and effectively with preservation of the uterus for future fertility. Several techniques reviewed in this video may be useful to reduce surgical morbidity and allow a minimally invasive approach.