This video demonstrate Laparoscopic myomectomy using pneumoperitoneum for large intramural myomas is considered a difficult and time-consuming procedure, requiring great skill to move a large uterus; to locate, grasp, enucleate, and remove a bulky myoma from the abdominal cavity; to achieve adequate hemostasis; and to repair the muscle layer.

Uterine fibroids (leiomyomas) are among the most common benign tumors affecting women of reproductive age. They can cause heavy menstrual bleeding, pelvic pain, infertility, and pressure symptoms depending on their size and location. Intramural fibroids—those located within the uterine muscle wall—are particularly challenging when large because they distort uterine anatomy and may affect fertility and pregnancy outcomes. Laparoscopic myomectomy has emerged as an advanced minimally invasive surgical technique that allows removal of fibroids while preserving the uterus.

World Laparoscopy Hospital (WLH) is globally recognized as a center of excellence for minimal access surgery, offering advanced patient care along with specialized laparoscopic training programs supported by hands-on practice and live surgical demonstrations.

Understanding Large Intramural Fibroids

Intramural fibroids develop within the myometrium and can enlarge the uterus significantly. The most common indications for surgical removal include:

• Heavy menstrual bleeding (metrorrhagia)

• Pelvic pain or pressure

• Infertility or recurrent pregnancy loss

• Enlarging pelvic mass

Studies show that intramural fibroids account for the majority of cases treated by laparoscopic myomectomy.

Large fibroids may increase surgical complexity because of:

• Increased blood supply leading to higher bleeding risk

• Difficulty in suturing deep uterine defects

• Limited working space during laparoscopy

However, experienced laparoscopic surgeons can safely manage even large fibroids with proper technique and patient selection.

Why Laparoscopic Myomectomy for Large Fibroids?

Laparoscopic myomectomy offers several advantages compared to open surgery:

1. Minimally Invasive Approach
Small incisions reduce postoperative pain and improve cosmetic outcomes.

2. Faster Recovery
Hospital stay is often shorter, sometimes less than 24–72 hours depending on complexity.

3. Fertility Preservation
The uterus is preserved, making it suitable for women planning pregnancy. Successful pregnancies have been reported after laparoscopic myomectomy.

4. Low Complication Rate
Research shows low complication rates and good symptom relief following laparoscopic myomectomy in selected patients.

Feasibility in Large and Giant Fibroids

Earlier, very large fibroids were considered a contraindication for laparoscopy. However, modern techniques have expanded its indications.

• Successful laparoscopic removal has been reported even in fibroids measuring >15–20 cm.

• Advanced strategies such as controlled tissue fragmentation and specialized trocar placement improve safety in large fibroid surgery.

This highlights that surgical expertise is the key factor rather than fibroid size alone.

Surgical Technique Overview

The typical laparoscopic myomectomy procedure involves:

1. Patient Positioning and Port Placement
Ports are placed strategically for optimal instrument movement and visualization.

2. Fibroid Localization and Enucleation
The fibroid is dissected from the uterine muscle carefully to minimize bleeding.

3. Uterine Reconstruction
Meticulous suturing is critical to restore uterine strength, especially in large intramural fibroids.

4. Specimen Retrieval
May involve contained morcellation or fragmentation techniques depending on safety considerations.

Role of World Laparoscopy Hospital

World Laparoscopy Hospital combines patient care with surgical education and research. Key strengths include:

• Advanced minimally invasive surgical infrastructure

• Internationally recognized training programs

• Live surgical demonstrations and hands-on skill training

• Expertise in complex laparoscopic and robotic procedures

The institute follows the philosophy of “Skilled Surgeon, Safer Surgery,” emphasizing precision and patient safety.

Postoperative Outcomes

Clinical studies show favorable outcomes after laparoscopic myomectomy:

• Significant symptom improvement

• Low recurrence rate in many cases

• Good fertility outcomes

• Early return to daily activities

Mean operative time and blood loss may increase with fibroid size, but complication rates generally remain comparable when performed by experienced surgeons.

Conclusion

Laparoscopic myomectomy for large intramural fibroids is a highly advanced minimally invasive surgical option that offers excellent clinical outcomes when performed by skilled surgeons. With modern technology, refined suturing techniques, and careful patient selection, even large fibroids can be managed laparoscopically with good safety and fertility preservation.