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This Video demonstrates Laparoscopic Myomectomy Lateral Wall Fibroid Uterus performed by Dr. R.K. Mishra at World Laparoscopy Hospital. Myomectomy is a surgical procedure to remove uterine fibroids — also called leiomyomas. These common noncancerous growths appear in the uterus. Uterine fibroids usually develop during childbearing years, but they can occur at any age.

The surgeon's goal during myomectomy is to take out symptom-causing fibroids and reconstruct the uterus. Unlike a hysterectomy, which removes your entire uterus, a myomectomy removes only the fibroids and leaves your uterus.

Women who undergo myomectomy report improvement in fibroid symptoms, including decreased heavy menstrual bleeding and pelvic pressure.

Laparoscopy was performed with the patient in the lithotomy position by using video monitoring equipment. The telescope was inserted subumbilically and one 6 mm port was placed suprapubically and medially. Two 5-mm ports were placed in the lower quadrants at the lateral edge of the rectus abdominis muscle.

Uterine fibroids, or leiomyomas, are benign tumors that commonly affect women of reproductive age. Among various types, lateral wall fibroids can cause significant symptoms such as heavy menstrual bleeding, pelvic pain, infertility, or pressure effects on the bladder and rectum. Laparoscopic myomectomy has emerged as a preferred minimally invasive approach for the removal of such fibroids, offering advantages like reduced postoperative pain, shorter hospital stay, and faster recovery compared to open surgery.

Understanding Lateral Wall Fibroids
Lateral wall fibroids develop along the side of the uterus and may vary in size, number, and location. Their position can make surgical removal more challenging due to proximity to important structures such as the uterine vessels, ureters, and broad ligament. Proper preoperative imaging using ultrasound or MRI is crucial to map the fibroid’s location and plan the surgical approach.

Indications for Laparoscopic Myomectomy
Laparoscopic myomectomy is indicated for women with lateral wall fibroids who experience:

Menorrhagia (heavy menstrual bleeding)

Pelvic pain or pressure

Infertility or recurrent pregnancy loss

Rapidly growing fibroids

It is also preferred in patients who desire uterine preservation and minimally invasive treatment.

Surgical Technique

Patient Preparation

General anesthesia is administered.

The patient is positioned in the lithotomy or supine position with Trendelenburg tilt for optimal pelvic exposure.

Port Placement

Typically, a 10–12 mm umbilical port is used for the camera, with additional 5 mm ports for instruments.

Port placement may be adjusted depending on fibroid size and location.

Identification of Fibroid

The lateral wall fibroid is visualized, and its relationship to surrounding structures is carefully assessed.

Vasopressin may be injected locally to reduce intraoperative bleeding.

Enucleation of Fibroid

A careful incision is made over the fibroid capsule.

Using blunt and sharp dissection, the fibroid is enucleated from the surrounding myometrium while preserving healthy uterine tissue.

Hemostasis and Suturing

Hemostasis is achieved using bipolar cautery or advanced energy devices.

The myometrial defect is closed using laparoscopic suturing techniques, such as Mishra’s Knot, to ensure secure closure and reduce the risk of adhesion formation.

Specimen Retrieval

Fibroids are removed via a morcellator or contained extraction bag to prevent tissue spillage.

Advantages of Laparoscopic Approach

Minimally invasive with smaller incisions

Reduced postoperative pain and faster recovery

Shorter hospital stay

Better cosmetic outcomes

Preservation of fertility

Postoperative Care

Patients are usually discharged within 24–48 hours.

Early ambulation is encouraged.

Follow-up imaging may be recommended to ensure complete fibroid removal.

Hormonal therapy may be considered in cases with multiple or recurrent fibroids.

Conclusion
Laparoscopic myomectomy for lateral wall fibroid uterus is a safe and effective technique when performed by experienced surgeons. It combines the benefits of minimally invasive surgery with meticulous preservation of uterine function, making it an ideal choice for women seeking symptomatic relief and fertility preservation.