This video demonstrates laparoscopic myomectomy for posterior wall fibroid uterus with endometriosis. Laparoscopic myomectomy is only appropriate when indi- cations for surgery have been met. Pelvic pain, pressure, and abnormal uterine bleeding are the most common symptoms that lead women to seek surgery for fibroids.

Uterine fibroids and endometriosis are two common gynecological conditions that frequently coexist and significantly affect a woman’s quality of life, fertility, and menstrual health. Posterior wall fibroids, in particular, pose surgical challenges due to their deep location near critical pelvic structures such as the rectum, uterosacral ligaments, and ureters. Laparoscopic myomectomy has emerged as the gold standard uterus-preserving surgical treatment when performed by skilled minimally invasive surgeons.

World Laparoscopy Hospital (WLH) is internationally recognized as a center of excellence in minimal access surgery, offering advanced laparoscopic and robotic surgical treatment along with global training programs and patient care services.

Understanding the Disease Condition

Posterior Wall Fibroid Uterus

Posterior wall fibroids arise from the back surface of the uterus and may cause:

• Chronic pelvic pain

• Severe dysmenorrhea

• Dyspareunia

• Infertility

• Pressure symptoms on rectum or bowel

Posterior fibroids are technically demanding to remove laparoscopically because of difficult visualization and limited working space.

Endometriosis Association

Endometriosis causes ectopic endometrial tissue deposits in pelvis leading to:

• Dense adhesions

• Distorted pelvic anatomy

• Increased surgical complexity

• Chronic inflammatory environment

Simultaneous management of fibroid and endometriosis is essential for symptom relief and fertility outcomes.

Why Laparoscopic Myomectomy?

Compared to open surgery, laparoscopic surgery offers:

• Less postoperative pain

• Minimal scar formation

• Reduced infection risk

• Faster recovery and shorter hospital stay

These advantages are core benefits of minimally invasive surgery and are routinely achieved in advanced laparoscopic centers.

Preoperative Evaluation

At advanced laparoscopic centers like WLH, preoperative workup includes:

• Pelvic ultrasound / MRI mapping

• Hemoglobin optimization

• Fertility planning (if needed)

• Endometriosis staging

• Anesthesia fitness

Proper case selection is key for successful minimally invasive surgery, especially in large or posterior fibroids.

Surgical Technique: Laparoscopic Myomectomy with Endometriosis Excision

Step 1: Patient Position and Port Placement

• General anesthesia

• Lithotomy + Trendelenburg position

• Strategic trocar placement based on fibroid location

Careful trocar planning is essential for posterior wall access.

Step 2: Pelvic Survey and Endometriosis Mapping

Surgeons identify:

• Ovarian endometriomas

• Deep infiltrating endometriosis

• Adhesions between uterus, bowel, and ovaries

Adhesiolysis is performed first to restore anatomy.

Step 3: Posterior Uterine Incision

Posterior uterine incision allows direct fibroid access.
Advanced energy devices help minimize thermal damage and blood loss while allowing precise dissection.

Step 4: Myoma Enucleation

• Fibroid capsule identification

• Gentle traction-counter traction

• Hemostasis maintained throughout

Accurate localization can be supported using laparoscopic ultrasound in complex cases.

Step 5: Myoma Bed Suturing

This is the most critical step:

• Multilayer closure

• Restoration of uterine integrity

• Prevention of uterine rupture in future pregnancy

Evidence suggests uterine rupture risk after proper repair is very low (≈ <1%).

Step 6: Endometriosis Excision / Ablation

Complete removal of endometriotic lesions improves:

• Pain relief

• Fertility outcomes

• Recurrence prevention

Step 7: Specimen Retrieval

Modern techniques focus on safe tissue removal using contained extraction or controlled fragmentation to avoid tissue spread risks.

Special Technical Challenges in Posterior Wall Fibroid

Surgeons must carefully manage:

• Ureter and uterine artery proximity

• Rectal injury risk

• Dense endometriotic adhesions

Studies show laparoscopic posterior myoma removal is safe when vital structures are identified and protected early.

Postoperative Recovery

Typical outcomes include:

• Early mobilization (within 24 hours)

• Discharge in 1–2 days

• Return to routine activity within 1–2 weeks

Minimally invasive surgery dramatically improves postoperative quality of life compared to open surgery.

Fertility Outcomes

Benefits include:

• Uterus preservation

• Improved implantation potential

• Reduced adhesion formation

Proper suturing and minimal thermal injury are crucial for future pregnancy success.

Role of Advanced Centers Like World Laparoscopy Hospital

WLH provides:

• Advanced laparoscopic and robotic surgery

• Hands-on simulation and live surgery training

• Evidence-based surgical protocols

• Global standard infrastructure

Trainees and surgeons gain exposure to real myomectomy and endometriosis surgeries under expert supervision.

Advantages of Treatment at World Laparoscopy Hospital

• NABH accredited and internationally recognized institute

• Multidisciplinary expert team

• State-of-the-art laparoscopic and robotic technology

• High success rate in advanced gynecologic laparoscopy

WLH focuses on integrating patient care, research, and surgical education in minimal access surgery.

Conclusion

Laparoscopic myomectomy for posterior wall fibroid uterus with associated endometriosis is a highly advanced minimally invasive procedure requiring excellent surgical skill and anatomical knowledge. When performed in high-volume centers like World Laparoscopy Hospital, patients benefit from precise surgery, faster recovery, improved fertility outcomes, and reduced complications.

With continuous innovation in laparoscopic technology, surgical training, and multidisciplinary care, institutions like WLH continue to lead global standards in minimally invasive gynecologic surgery.