This video demonstrates Laparoscopic Myomectomy for Intramural Fibroid using Baseball Suturing by Dr. R K Mishra at World Laparoscopy Hospital. The ‘baseball’ suture technique for closure of the uterine incision is a safe and effective method for use in laparoscopic myomectomy. Uterine leiomyoma (fibroid) is the most common benign tumor in the reproductive system of women of childbearing age, with a prevalence of between 30–35%. Myomectomy is the treatment of choice for women who have symptoms and who wish to preserve their future fertility. During the last two decades, there have been rapid developments in minimally invasive surgical methods for myomectomy, and currently, a variety of endoscopic techniques are now used, including laparoscopy, hysteroscopy, and robotic-assisted surgery.

Uterine fibroids, also known as leiomyomas, are common benign tumors affecting women of reproductive age. Among them, intramural fibroids—those located within the muscular wall of the uterus—can cause symptoms such as heavy menstrual bleeding, pelvic pain, and infertility. Surgical removal, when necessary, aims to preserve uterine integrity, especially in women desiring future fertility. Laparoscopic myomectomy has emerged as a minimally invasive alternative to open surgery, offering less postoperative pain, quicker recovery, and minimal scarring.

Understanding Intramural Fibroids
Intramural fibroids develop within the myometrium, the muscular layer of the uterus. Their location can distort the uterine cavity, impair fertility, and increase the risk of miscarriage. Treatment is indicated for symptomatic cases, rapid fibroid growth, or infertility issues. Laparoscopic myomectomy is particularly suited for fibroids that are moderate in size and accessible via minimally invasive techniques.

Laparoscopic Approach
Laparoscopic myomectomy involves small abdominal incisions through which a camera and specialized instruments are inserted. The surgeon visualizes the fibroid and surrounding uterus on a high-definition monitor, allowing precise excision with minimal trauma to the surrounding tissue.

Steps of Laparoscopic Myomectomy for Intramural Fibroids:

Patient Preparation: The patient is positioned under general anesthesia, with prophylactic antibiotics administered.

Port Placement: Typically, a 10-mm umbilical port is used for the laparoscope, and 5-mm ports are placed strategically for surgical instruments.

Fibroid Localization: The uterus is examined, and the fibroid’s location is confirmed via laparoscopic visualization, sometimes aided by intraoperative ultrasound.

Myometrial Incision: A careful incision is made over the fibroid, maintaining adequate myometrial thickness around the defect to allow proper closure.

Fibroid Enucleation: The fibroid is dissected from the myometrium using atraumatic graspers and energy devices, ensuring minimal bleeding.

Hemostasis: Bleeding is controlled using bipolar cautery or sutures before uterine closure.

Baseball Suturing Technique
One of the critical steps in laparoscopic myomectomy is suturing the myometrium to restore uterine integrity and minimize postoperative adhesions. The baseball suturing technique is highly effective for this purpose:

Concept: The suture is passed in a continuous fashion along the edges of the myometrial defect, resembling the stitching on a baseball.

Advantages:

Provides uniform tension along the wound

Ensures hemostasis

Reduces dead space and prevents hematoma formation

Supports faster healing and maintains uterine strength

Procedure:

A barbed or absorbable suture is used.

The needle is passed sequentially from one edge of the incision to the other in a cross-over pattern.

Continuous stitching closes the defect completely without gaps.

Knotting may be minimal or not required if using barbed sutures.

Specimen Retrieval
The excised fibroid is removed using a specimen retrieval bag, often with morcellation if the fibroid is large. This ensures minimal tissue spillage and reduces the risk of postoperative complications.

Postoperative Care
Patients typically experience reduced pain and a shorter hospital stay compared to open myomectomy. Postoperative monitoring includes:

Pain management

Early ambulation

Monitoring for bleeding or infection

Advantages of Laparoscopic Myomectomy with Baseball Suturing

Minimally invasive with small scars

Reduced blood loss and postoperative pain

Faster recovery and early return to daily activities

Excellent cosmetic results

Strong uterine wall closure, especially important for future pregnancies

Conclusion
Laparoscopic myomectomy for intramural fibroids using the baseball suturing technique is a safe and effective approach for women seeking symptom relief and fertility preservation. This minimally invasive method ensures precise fibroid removal, strong uterine repair, and quicker recovery. Surgeons skilled in laparoscopic techniques and advanced suturing can provide optimal outcomes for patients with intramural fibroids.