This video demonstrate Hysteroscopic myomectomy is the preferred method when fibroids are submucosal or when most of an intramural fibroid protrudes into the uterine cavity [9]. Hysteroscopic resection of submucous fibroids is considered as a simple, well-tolerated and effective procedure.

Uterine fibroids (leiomyomas) are among the most common benign tumors affecting women of reproductive age. Intramural fibroids arise within the muscular wall of the uterus, and when they extend toward or into the uterine cavity (submucosal extension), they can cause heavy menstrual bleeding, infertility, recurrent pregnancy loss, and pelvic pain. Laparoscopic myomectomy is a minimally invasive surgical technique designed to remove fibroids while preserving the uterus and fertility potential.

Myomectomy is one of the key uterus-preserving treatments for fibroids alongside other modalities such as embolization, focused ultrasound, and hormonal therapies.

About World Laparoscopy Hospital (WLH)

World Laparoscopy Hospital is globally recognized for advanced laparoscopic and robotic surgery training, treatment, and research. It has trained thousands of surgeons and gynecologists worldwide and is known for high standards of minimally invasive surgical education and patient care.

At WLH, advanced gynecologic laparoscopic procedures such as laparoscopic myomectomy are performed using modern technology, evidence-based surgical protocols, and expert surgical mentorship.

Understanding Intramural Myoma with Submucosal Extension

Intramural fibroids grow within the uterine muscle, while submucosal extension means part of the fibroid bulges into the uterine cavity. This type is clinically important because it can:

• Distort the uterine cavity

• Cause heavy or prolonged periods

• Lead to infertility or repeated miscarriages

• Cause pressure symptoms or pain

Because fertility preservation is often a key goal, laparoscopic myomectomy is frequently preferred over hysterectomy when feasible.

Why Laparoscopic Myomectomy?

Minimally invasive gynecologic surgery provides major advantages compared to open surgery, including:

• Smaller incisions and minimal scarring

• Less postoperative pain

• Faster recovery and earlier return to work

• Shorter hospital stay

• Lower infection and blood loss risk

These benefits are widely associated with laparoscopic gynecologic procedures in general.

Preoperative Evaluation at WLH

Before laparoscopic myomectomy, patients typically undergo:

• Detailed clinical history and examination

• Ultrasound or MRI pelvis

• Hemoglobin and hormonal profile

• Fertility counseling (if planning pregnancy)

Careful preoperative mapping is essential in intramural fibroids with cavity extension to minimize uterine damage and preserve reproductive outcomes.

Surgical Technique (Step-by-Step Overview)

1. Patient Preparation

• General anesthesia

• Lithotomy position

• Uterine manipulator insertion for better surgical exposure

2. Port Placement

Typically 3–4 small laparoscopic ports are inserted through the abdomen.

3. Myoma Localization

• Identification using laparoscopic visualization

• Sometimes assisted by intraoperative ultrasound

4. Uterine Incision

• Serosal incision over fibroid

• Vasopressin injection may be used to reduce bleeding

5. Myoma Enucleation

• Fibroid carefully dissected from surrounding myometrium

• Special care taken if fibroid extends into uterine cavity

6. Uterine Reconstruction

• Multilayer suturing to restore uterine strength

• Essential for future pregnancy safety

7. Specimen Retrieval

• Morcellation or removal via small incision

Fertility and Pregnancy Outcomes

Many patients undergo myomectomy specifically to improve fertility. Community experiences and clinical guidance often indicate:

• Fertility is usually preserved

• Pregnancy is often possible after healing

• Conception is sometimes advised after 3–6 months depending on healing

(These timelines vary individually and require surgeon guidance.)

Postoperative Recovery

Typical recovery after laparoscopic myomectomy includes:

• Hospital stay: 24–48 hours (varies by case)

• Return to daily activities: 1–2 weeks

• Full recovery: 4–6 weeks

Advantages of Treatment at World Laparoscopy Hospital

• Highly specialized minimally invasive surgeons

• Advanced laparoscopic and robotic technology

• Global training and academic environment

• Evidence-based surgical protocols

• Focus on fertility-preserving surgery

Conclusion

Laparoscopic myomectomy for intramural myoma with submucosal extension is a technically demanding but highly effective fertility-preserving procedure. At World Laparoscopy Hospital, this surgery is performed with precision, advanced technology, and global surgical expertise. The minimally invasive approach ensures faster recovery, reduced complications, and excellent reproductive outcomes for women who wish to preserve their uterus and fertility.