This video Demonstrates Laparoscopic Myomectomy with Baseball Suturing. Uterine leiomyoma (fibroid) is the most common benign tumor in the reproductive system of women of childbearing age. Demonstration of the ‘baseball’ suture technique for uterine myomectomy. The first stitch is made with a 1-0 absorbable suture at the top of the incision and tied with a knot. Next, the suture needle is shown to be inserted into the bottom of the cavity, which results from enucleation of the uterine leiomyoma, and the needle is passed through the left side of the incision. After the suture is pulled tight, the suture needle is again inserted into the bottom of the enucleation cavity and passed through the right side of the incision. The final appearance of the sutured uterine incision, which resembles the stitches on a ‘baseball.’ This video has shown that the ‘baseball’ suture technique for laparoscopic uterine myomectomy, following enucleation of uterine leiomyoma, is a safe and effective suture method.

Laparoscopic myomectomy is a well-established minimally invasive surgical procedure performed to remove uterine fibroids (leiomyomas) while preserving the uterus. It is especially beneficial for women who wish to retain fertility or avoid hysterectomy. With advances in laparoscopic suturing techniques, baseball suturing has emerged as an effective and secure method for uterine defect closure following fibroid enucleation, ensuring excellent hemostasis and strong myometrial approximation.

Understanding Laparoscopic Myomectomy

Uterine fibroids are common benign tumors arising from the smooth muscle of the uterus. They may cause symptoms such as heavy menstrual bleeding, pelvic pain, infertility, and recurrent pregnancy loss. Laparoscopic myomectomy offers several advantages over open surgery, including reduced blood loss, minimal postoperative pain, shorter hospital stay, faster recovery, and better cosmetic outcomes.

The success of laparoscopic myomectomy depends not only on meticulous fibroid removal but also on proper suturing of the uterine defect, which is critical for uterine integrity, hemostasis, and future reproductive outcomes.

What Is Baseball Suturing?

Baseball suturing is a continuous laparoscopic suturing technique in which the needle passes alternately from one side of the incision to the other in a spiral or zig-zag fashion, resembling the stitches on a baseball. This technique allows for:

Uniform distribution of tension

Excellent approximation of myometrial edges

Effective obliteration of dead space

Secure hemostasis with minimal tissue ischemia

Baseball suturing is particularly useful in closing deep myometrial defects created after fibroid enucleation.

Indications for Baseball Suturing in Myomectomy

Baseball suturing is preferred in:

Moderate to large intramural fibroids

Deep myometrial defects

Fertility-preserving surgeries

Situations where strong uterine wall reconstruction is required

Cases demanding minimal suture bulk and maximum strength

Preoperative Preparation

A thorough preoperative evaluation is essential and includes:

Pelvic ultrasound or MRI to assess fibroid size, number, and location

Correction of anemia if present

Use of GnRH analogs or selective progesterone receptor modulators (if indicated)

Informed consent explaining surgical technique, fertility outcomes, and risks

Surgical Technique
1. Port Placement and Exposure

Standard laparoscopic ports are placed, usually including one umbilical camera port and two or three accessory ports. Proper uterine manipulation is essential to expose the fibroid.

2. Vasopressin Injection

Diluted vasopressin is injected into the myometrium around the fibroid to reduce blood loss and improve the surgical field.

3. Incision and Fibroid Enucleation

A transverse or vertical incision is made over the most prominent part of the fibroid. Traction and counter-traction are applied to enucleate the fibroid from its pseudocapsule, preserving healthy myometrium.

4. Hemostasis

Meticulous hemostasis is achieved using bipolar energy or minimal coagulation to prevent tissue necrosis.

5. Baseball Suturing Technique

A delayed-absorbable suture (e.g., polyglactin or barbed suture) is used

Suturing begins at one end of the myometrial defect

The needle is passed alternately from one edge of the incision to the other in a continuous spiral pattern

Each bite includes adequate depth to approximate myometrial layers securely

Dead space is obliterated effectively

The suture is continued until complete closure is achieved

In larger defects, a two-layer closure may be performed:

Deep myometrial layer with baseball suturing

Superficial serosal layer with continuous or Lembert sutures

Advantages of Baseball Suturing

Provides strong uterine wall reconstruction

Reduces intraoperative and postoperative bleeding

Ensures better healing and scar strength

Minimizes risk of uterine rupture in future pregnancy

Reduces operative time once mastered

Improves cosmetic appearance of the uterine surface

Postoperative Care

Early ambulation and pain control

Monitoring for bleeding or infection

Discharge usually within 24–48 hours

Follow-up imaging if clinically indicated

Advice on delayed conception (typically 3–6 months) for optimal uterine healing

Complications and Prevention

Potential complications include bleeding, hematoma formation, infection, and adhesion formation. These can be minimized by:

Proper surgical planning

Gentle tissue handling

Accurate suturing technique

Adequate hemostasis and adhesion prevention measures

Role in Fertility Preservation

Laparoscopic myomectomy with baseball suturing plays a vital role in fertility-preserving gynecologic surgery. Strong and uniform uterine closure enhances endometrial and myometrial healing, supporting future pregnancies and reducing obstetric risks.

Conclusion

Laparoscopic myomectomy with baseball suturing represents a refined surgical approach combining minimal invasiveness with robust uterine reconstruction. Mastery of baseball suturing significantly enhances surgical outcomes by ensuring excellent hemostasis, strong scar formation, and preservation of fertility. With proper training and experience, this technique is an invaluable skill for modern laparoscopic surgeons, offering safe, effective, and patient-centered care in the management of uterine fibroids.