Posterior cervico-vaginal myomectomy: a laparoscopic technique

Abstract

Objective. Uterine myoma is considered the most common gynaecological benign neoplasm occurring in 50-60% of women. Generally, the patients are asymptomatic, but almost a third of women with leiomyomas will require treatment due to symptoms such as heavy uterine bleeding, severe pelvic pain, bulk symptoms, dyspareunia or infertility. Cervical myomas are uncommon, with a prevalence of only 0.6%. Vaginal approach is the classical option for their removal, but when it is impossible, in some cases laparoscopy may be an alternative. This article aims to describe a safe laparoscopic technique for a complete removal of a large cervico-vaginal myoma, the removal of which was impossible with a classical vaginal approach due to its size. Description of the technique. In consideration of the myoma's size, location, characteristics and the impossible vaginal approach, the patient was considered eligible for a laparoscopic myomectomy. Followings are the main surgical steps: set up of surgical view of the intervention field; vertical posterior colpotomy; myoma's peduncle identification and incision; reduction of myoma's size with power morcellation within the vagina; extraction of the fibroid from the vagina to the peritoneal cavity through the colpotomy; completion of the power morcellator and extraction of the whole specimen; colporrhaphy; peritoneal washing. Conclusions. When the vaginal approach is not practicable, laparoscopic management of large myomas in difficult locations such as the cervico-vaginal region seems to be a feasible and a safe surgical option.

Surgical adhesions after laparoscopic myomectomy: methods of prevention

“…Oxidized regenerated cellulose (ORC) adhesion barrier showed a significant decrease in the uterine adhesion score in the intervention group only for a posterior localization of myomas (p=0.007) and when considering an anterior localization of myomas were not significant decrement the incidence of de novo adhesions (odds ratio=1.11; p=0.693), in the total adhesion score and in the uterine score [64][65][66][67].…”