Laparoscopically-assisted vaginal polymyomectomy overcoming usual size limits of minimally invasive surgery-A case report
Abstract
Uterine fibroids are the most common benign tumors affecting young women. Symptomatic fibroids require treatment.
Surgical options include the conventional laparotomy, the laparoscopic and the vaginal routes. Excessive size, number and location of the fibroids are considered limitations to the minimally invasive surgery, i.e. laparoscopic and the vaginal approaches.
We report a successful treatment of a large myomatous uterus with both large and multiple fibroids in a nulliparous women to demonstrate that the laparoscopically assisted vaginal approach performed by an experienced surgical team with good anesthetic care may overcome all the generally acknowledged limits. We report the case of a 43-year-old nulliparous Caucasian woman presenting with a large myomatous uterus.
Clinical examination revealed a globular uterus reaching the umbilicus and imaging showed multiple intramural and subserous typical leiomyomas, the largest was a posterior cervico-isthmic myoma of 103 x 94 x 59 mm and 4 fibroids above 58 mm diameter. A laparoscopic-assisted vaginal approach was decided.
First, by laparoscopy we resected a total of 7 fibroids of 10 to 80 mm then we completed the procedure by a vaginal myomectomy of the largest 120 mm fibroid. All leiomyomas were removed from the intraperitoneal cavity via posterior culdotomy, the largest fibroid required vaginal morcellation.
Postoperative recovery was fast and uncomplicated. Laparoscopic myomectomy is the gold standard management of uterine fibroids.
The size, location and number of the fibroids were considered limitations of this technique. Laparoscopicaly assisted vaginal myomectomy performed by a well-trained surgical team and a good anesthetic care may overcome theacknowledged limits for minimally invasive myomectomy even in case of nulliparous women.