Laparoscopic Submucous Myomectomy performed by Prof. Dr. R. K. Mishra, Laparoscopy Hopital, New Delhi, India. Learn more about Submucous Myomectomy at http://www.laparoscopyhospital.com

This educational video demonstrates step-by-step surgical management of submucous fibroids using laparoscopic precision, highlighting patient safety, fertility preservation, and faster recovery. The video is designed for surgeons, gynecologists, and medical trainees who want to understand modern laparoscopic myomectomy techniques in real operative settings.

This high-quality video also reflects the standardized surgical training and global teaching methodology followed at the institute, helping surgeons upgrade their minimally invasive surgery skills.

Laparoscopic submucous myomectomy is an advanced minimally invasive surgical technique used for the removal of submucous fibroids that have significant intramural extension or are large in size. At institutions such as World Laparoscopy Hospital, this surgery represents a blend of precision laparoscopy, advanced suturing skills, and fertility-preserving gynecologic surgery. Submucous fibroids originate from the inner uterine wall and can cause symptoms such as heavy menstrual bleeding, infertility, and recurrent pregnancy loss.

Traditionally, small submucous fibroids are treated using hysteroscopic resection. However, when fibroids are large (>4–5 cm) or deeply embedded in the uterine wall, laparoscopic myomectomy is often preferred for complete and safer removal.

Indications of Laparoscopic Submucous Myomectomy

The laparoscopic approach is considered in the following situations:

• Large submucous fibroids (>4–5 cm)

• Type II submucous fibroids with >50% intramural extension

• Multiple fibroids with mixed locations

• Failed or incomplete hysteroscopic resection

• Fertility preservation with complete fibroid removal

Studies show that laparoscopic myomectomy provides advantages in larger type II submucous fibroids, whereas hysteroscopic surgery is more suitable for smaller lesions.

Preoperative Evaluation

At advanced laparoscopic centers, careful evaluation is essential:

• Transvaginal ultrasound or MRI fibroid mapping

• Classification using FIGO or STEP-W system

• Hemoglobin optimization

• Bowel preparation and antibiotic prophylaxis

Fibroid mapping helps assess size, depth, and cavity involvement to determine the safest surgical route.

Surgical Technique (Step-by-Step)

1. Patient Position and Port Placement

The patient is placed in lithotomy position under general anesthesia.
Standard laparoscopic ports are placed:

• Umbilical camera port

• Accessory working ports in lower abdomen

This approach allows complete visualization and safe instrument handling.

2. Vasopressin Injection and Hemostasis

Diluted vasopressin is injected into the myometrium around the fibroid to reduce blood loss and create a dissection plane.

3. Uterine Incision

A serosal incision is made over the fibroid using energy devices such as harmonic scalpel, monopolar energy, or laser depending on surgeon preference.

4. Myoma Enucleation

The fibroid is dissected along the pseudocapsule using traction and counter-traction techniques.
In submucous fibroids, special care is taken to avoid excessive endometrial damage.

5. Endometrial Cavity Repair

If the uterine cavity is opened, it is carefully sutured to maintain fertility and reduce risk of uterine rupture in future pregnancy. Proper multilayer closure is essential.

6. Myometrial Reconstruction

Layer-by-layer suturing restores uterine strength.
Proper suturing significantly reduces risk of uterine rupture in future pregnancies.

7. Specimen Retrieval

The fibroid is removed via morcellation or mini-laparotomy depending on size.

Advantages of Laparoscopic Submucous Myomectomy

• Minimal blood loss

• Faster recovery

• Smaller incisions

• Better visualization of deep fibroids

• Ability to treat multiple fibroids simultaneously

Clinical studies show median blood loss around 50 mL and operative time about 60–75 minutes in many cases.

Challenges and Risk Considerations

• Opening of endometrial cavity

• Need for expert laparoscopic suturing

• Risk of uterine rupture if closure is inadequate

• Avoidance of excessive thermal damage

These risks are minimized when surgery is performed by highly trained laparoscopic surgeons.

Postoperative Care

• Early mobilization

• Short hospital stay (often 1–2 days)

• Fertility planning counseling

• Follow-up ultrasound

Outcomes and Fertility

With proper uterine repair, pregnancy outcomes are generally favorable. Studies indicate that when myometrium is adequately sutured, uterine rupture risk remains low.

Role of World Laparoscopy Hospital

At World Laparoscopy Hospital, advanced laparoscopic gynecologic procedures are performed with focus on:

• Evidence-based minimally invasive surgery

• Advanced laparoscopic suturing training

• Fertility-preserving surgical principles

• Live surgical demonstrations and teaching programs

Conclusion

Laparoscopic submucous myomectomy is a technically demanding but highly effective surgery for large or deeply embedded submucous fibroids. When performed by skilled laparoscopic surgeons, it offers excellent clinical outcomes, minimal complications, and fertility preservation. With advancements in energy devices, suturing techniques, and imaging, this procedure continues to expand its role in modern gynecologic surgery.