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This video demonstrates Laparoscopic Myomectomy for Posterior Wall Myoma performed by Dr. R K Mishra at World Laparoscopy Hospital. Multiple fibroids, including large fibroids, can be removed during a laparoscopic or robotic myomectomy procedure. Your surgeon will perform a thorough examination and review your MRI with you to plan the laparoscopic myomectomy.

Uterine fibroids, or leiomyomas, are benign smooth muscle tumors of the uterus, affecting a significant number of women of reproductive age. Among them, posterior wall myomas—fibroids located at the back wall of the uterus—can present unique surgical challenges due to their location near the uterine serosa and surrounding pelvic structures. Laparoscopic myomectomy has become the preferred approach for these fibroids, offering the benefits of minimally invasive surgery including reduced postoperative pain, shorter hospital stays, and faster recovery.

Indications
Laparoscopic myomectomy is typically indicated for women with:

Symptomatic posterior wall fibroids causing pelvic pain, abnormal uterine bleeding, or pressure symptoms

Infertility related to uterine distortion

Large fibroids interfering with normal uterine function

Preoperative Evaluation
A thorough preoperative assessment is crucial. This includes:

Ultrasound or MRI to determine the size, number, and location of fibroids

Hematological tests to check for anemia due to heavy bleeding

Assessment of reproductive plans, as fertility preservation is often a priority

Surgical Technique
Laparoscopic myomectomy for posterior wall myomas involves several key steps:

Patient Positioning and Port Placement

The patient is placed in a dorsal lithotomy position with Trendelenburg tilt.

Ports are strategically placed to provide optimal access to the posterior uterine wall.

Fibroid Localization and Dissection

The posterior wall fibroid is identified using laparoscopic visualization and intraoperative ultrasonography if needed.

Vasopressin may be injected to reduce intraoperative bleeding.

A precise incision is made over the fibroid, and the fibroid is carefully enucleated.

Hemostasis and Suturing

Hemostasis is maintained throughout using electrocautery or advanced energy devices.

The uterine defect is closed with intracorporeal or extracorporeal suturing techniques to restore uterine integrity and prevent adhesions.

Advanced suturing techniques like Mishra’s Knot can improve efficiency and safety.

Specimen Retrieval

The removed fibroid is retrieved through morcellation or mini-laparotomy, depending on size and location.

Advantages of Laparoscopic Myomectomy

Minimally invasive with smaller incisions

Reduced postoperative pain and faster recovery

Less blood loss compared to open myomectomy

Preservation of uterine anatomy, beneficial for women planning future pregnancies

Postoperative Care

Early ambulation and pain management are recommended

Follow-up imaging may be done to assess healing

Fertility counseling for women desiring pregnancy

Conclusion
Laparoscopic myomectomy for posterior wall myomas is a safe, effective, and fertility-preserving surgical option when performed by experienced surgeons. With advancements in laparoscopic techniques and suturing methods, patients can expect excellent outcomes with minimal recovery time.

For more information https://www.laparoscopyhospital.com
World Laparoscopy Hospital
Cyber City, Gurugram, NCR Delhi
INDIA 122002
Phone & WhatsApp: +919811416838, + 91 9999677788