Uterine fibroids, also known as leiomyomas, are among the most common benign tumors affecting women of reproductive age. While many fibroids remain asymptomatic and small, there are cases where they can grow to an enormous size, severely affecting a woman’s health and quality of life. One such remarkable case was recently managed at World Laparoscopy Hospital (WLH), Gurgaon, where a 24 cm giant posterior wall fibroid uterus was successfully treated using advanced laparoscopic surgery under the leadership of Prof. Dr. R. K. Mishra and his expert surgical team.

Understanding Giant Uterine Fibroids

Fibroids usually range between 1 cm to 10 cm in size; however, giant fibroids measuring more than 20 cm are rare and pose significant surgical challenges. When such fibroids arise from the posterior wall of the uterus, they can press against adjacent organs like the rectum, urinary bladder, and pelvic vessels, causing:

Severe pelvic pain and pressure
Heavy menstrual bleeding
Constipation and urinary frequency
Abdominal distension mimicking pregnancy
Infertility or miscarriage in reproductive-age women

A 24 cm fibroid, as encountered in this case, is extremely rare and requires high surgical precision and advanced minimally invasive techniques to remove it safely.

Case at World Laparoscopy Hospital

The patient presented with complaints of:

Chronic pelvic pain
Excessive menstrual bleeding
Progressive abdominal enlargement
Discomfort in bowel and bladder function

Upon clinical examination and imaging (ultrasound and MRI), a giant 24 cm posterior wall fibroid was diagnosed. Traditionally, such cases are managed by open abdominal hysterectomy or myomectomy due to the massive size. However, at WLH, the surgical team opted for laparoscopic management, showcasing their expertise in handling highly complex cases with minimally invasive techniques.

The Laparoscopic Procedure

The surgery was meticulously planned and executed with the following steps:

1. Preoperative Planning

Comprehensive evaluation with imaging and blood investigations
Anesthesia preparation and strategy for anticipated blood loss
Use of vasopressin to minimize intraoperative bleeding

2. Port Placement and Access

Special port placement was used to accommodate the enlarged uterus occupying most of the abdomen
High-definition 4K laparoscopic equipment provided magnified visualization

3. Myomectomy / Hysterectomy

Careful dissection around the posterior uterine wall was performed
The giant fibroid was enucleated without injuring vital pelvic structures
In selected cases, uterus preservation (myomectomy) was possible; otherwise, total laparoscopic hysterectomy was performed

4. Specimen Retrieval

The fibroid, weighing several kilograms, was retrieved using contained morcellation technique to ensure safety and avoid tissue spillage

5. Hemostasis and Closure

Meticulous suturing of the uterine wall (if myomectomy)
Hemostasis achieved with minimal blood loss
Ports closed cosmetically, leaving only small scars

Challenges and Surgical Expertise

Performing laparoscopic surgery for a 24 cm posterior wall fibroid requires advanced surgical skills because of:

Distorted pelvic anatomy
Limited working space due to massive uterus
Risk of excessive bleeding
Difficulty in specimen retrieval

The surgical team at WLH overcame these challenges with precision laparoscopic suturing, innovative surgical strategies, and years of specialized experience.

Advantages of Laparoscopic Surgery Over Open Surgery

Compared to open surgery, the laparoscopic approach provided the patient with several benefits:

Smaller incisions with minimal scarring
Reduced blood loss
Faster recovery and shorter hospital stay
Lower risk of infection and postoperative pain
Preservation of fertility in selected cases

Outcome and Recovery

The surgery was completed successfully with minimal blood loss and no intraoperative complications. The patient recovered quickly and was discharged within a few days. Follow-up showed excellent healing, improved quality of life, and complete relief from symptoms.

World Laparoscopy Hospital – A Global Leader in Advanced Surgery

This case highlights why World Laparoscopy Hospital is recognized globally as a center of excellence for minimally invasive surgery. Under the guidance of Prof. Dr. R. K. Mishra, WLH has consistently demonstrated its capability to manage the most complex gynecological and general surgical cases with advanced laparoscopic and robotic techniques.

The hospital is not only a premier surgical institute but also a renowned training center, where surgeons and gynecologists from around the world learn the art and science of minimal access surgery.

Conclusion

The successful laparoscopic management of a 24 cm giant posterior wall fibroid uterus at World Laparoscopy Hospital represents a landmark achievement in the field of minimally invasive gynecology. It proves that with advanced technology, expert skills, and innovative surgical planning, even the largest and most challenging fibroids can be treated safely without the need for open surgery.

For patients worldwide, WLH continues to bring hope by making complex surgeries safer, less painful, and faster in recovery, reaffirming its position as a global leader in laparoscopic and robotic surgery.