This video provides a comprehensive demonstration of Laparoscopic Myomectomy for Submucous Myoma, highlighting advanced minimally invasive surgical techniques used for the safe and effective removal of uterine fibroids. Submucous myomas are a common cause of abnormal uterine bleeding, infertility, and pelvic pain, and laparoscopic management offers excellent outcomes with faster recovery.

The procedure is explained step by step, including patient selection, port placement, myoma enucleation, precise hemostasis, uterine wall reconstruction, and specimen retrieval. This video is highly beneficial for gynecologists, laparoscopic surgeons, and surgical trainees seeking to enhance their skills in advanced gynecologic laparoscopy.

Laparoscopic myomectomy for large submucous myomas is a technically feasible procedure. It can be performed by experienced surgeons irrespective of the size or depth of the myoma. It prevents the complications of hysteroscopic removal of the myoma.

Removal of fibroids is beneficial in the treatment of heavy menstrual bleeding for women. Hysteroscopic resection of fibroids is a minimally invasive, safe, and effective treatment for submucosal fibroids. Laparoscopic myomectomy is the preferred choice in selected cases when abdominal removal of fibroids is required.

Submucous myomas are benign smooth muscle tumors of the uterus that develop just beneath the endometrial lining. Although non-cancerous, they are clinically significant because of their strong association with abnormal uterine bleeding, infertility, recurrent pregnancy loss, and pelvic discomfort. With advancements in minimally invasive surgery, laparoscopic myomectomy has emerged as a safe and effective treatment option for selected cases of submucous myoma, offering excellent surgical outcomes while preserving the uterus and fertility.

Understanding Submucous Myoma

Submucous myomas are classified based on their relationship with the uterine cavity:

Type 0: Completely intracavitary

Type I: <50% intramural extension

Type II: ≥50% intramural extension

While hysteroscopic myomectomy is often preferred for purely intracavitary fibroids, laparoscopic myomectomy is particularly useful for larger submucous myomas with significant intramural components, where hysteroscopic access may be limited or unsafe.

Indications for Laparoscopic Myomectomy

Laparoscopic myomectomy is indicated in patients with:

Symptomatic submucous myoma causing menorrhagia or anemia

Infertility or recurrent pregnancy loss attributed to fibroids

Large Type I or Type II submucous myomas

Failed or contraindicated hysteroscopic myomectomy

Desire for uterine conservation and future fertility

Preoperative Evaluation

A thorough preoperative assessment is essential and includes:

Transvaginal ultrasonography

Saline infusion sonography (SIS)

MRI for precise mapping of myoma size, location, and depth

Correction of anemia and optimization of patient health

Counseling regarding risks, benefits, and fertility outcomes

Surgical Technique
Patient Positioning and Port Placement

The patient is placed in the dorsal lithotomy position under general anesthesia. Pneumoperitoneum is established, and standard laparoscopic ports are inserted to allow optimal visualization and instrument maneuverability.

Vasopressin Injection

Diluted vasopressin is injected into the myometrium surrounding the myoma to reduce intraoperative blood loss and improve surgical planes.

Myoma Enucleation

A serosal incision is made over the bulge of the myoma using monopolar energy or harmonic scalpel. The fibroid is gently enucleated by traction and counter-traction, preserving the surrounding myometrium and endometrium.

Uterine Reconstruction

Meticulous multilayer suturing of the uterine defect is performed using delayed-absorbable sutures to restore uterine integrity and reduce the risk of uterine rupture in future pregnancies.

Specimen Retrieval

The myoma is removed using contained morcellation or through a mini-laparotomy, adhering to current safety guidelines.

Advantages of Laparoscopic Approach

Reduced postoperative pain

Minimal blood loss

Shorter hospital stay

Faster recovery and return to daily activities

Improved cosmetic outcomes

Preservation of fertility and uterine anatomy

Postoperative Care and Recovery

Patients typically recover quickly, with most discharged within 24–48 hours. Analgesics, early ambulation, and follow-up imaging may be advised. Pregnancy is usually recommended after a healing period of 3–6 months, depending on uterine reconstruction.

Complications and Risk Management

Although rare, potential complications include:

Bleeding

Infection

Adhesion formation

Endometrial breach

Uterine rupture in subsequent pregnancy (rare with proper suturing)

Careful patient selection and surgical expertise significantly reduce these risks.

Fertility Outcomes

Multiple studies have shown improved fertility and pregnancy outcomes following laparoscopic myomectomy for submucous myoma. Restoration of normal uterine cavity anatomy plays a crucial role in enhancing implantation and reducing miscarriage rates.

Conclusion

Laparoscopic myomectomy for submucous myoma is a highly effective, fertility-preserving surgical option in appropriately selected patients. When performed by skilled laparoscopic surgeons, it offers excellent clinical outcomes with minimal morbidity. As minimally invasive gynecologic surgery continues to evolve, laparoscopic myomectomy remains a cornerstone in the management of complex uterine fibroids.

For More information:

https://www.laparoscopyhospital.com

World Laparoscopy Hospital
Cyber City, Gurugram, NCR Delhi
INDIA: +919811416838

World Laparoscopy Training Institute
Bld.No: 27, DHCC, Dubai
UAE: +971525857874

World Laparoscopy Training Institute
8320 Inv Dr, Tallahassee, Florida
USA : +1 321 250 7653