This video demonstrates Laparoscopic Myomectomy for Large Deep Intramural Myoma which was intending the cavity. Laparoscopic myomectomy using pneumoperitoneum for large myomas like 12 cm or more is now very popular altho it is difficult by several factors, such as the increased operative time, the risk of perioperative bleeding, and the risk of conversion to laparotomy. With the introduction of skilled surgeons in laparoscopy using good suturing skills, this procedure can be performed using laparoscopic surgical instruments introduced through small abdominal incisions. The aim of this video is to evaluate the feasibility, reproducibility, and safety of laparoscopic myomectomy for very large myomas ≥10 cm using three-port.

Uterine fibroids (myomas) are common benign tumors of the uterus, affecting a significant number of women during their reproductive years. Among them, large deep intramural myomas—fibroids located within the muscular wall of the uterus—pose a unique surgical challenge due to their size and location. These fibroids can cause heavy menstrual bleeding, pelvic pain, infertility, and pressure symptoms.

Laparoscopic Myomectomy: A Minimally Invasive Solution
Traditionally, large intramural myomas were managed with open abdominal surgery (laparotomy). However, advances in minimally invasive surgery have made laparoscopic myomectomy a safe and effective alternative, offering multiple benefits:

Smaller incisions

Reduced postoperative pain

Shorter hospital stay

Faster recovery

Better cosmetic results

Lower risk of adhesions

Preoperative Assessment
Before surgery, careful evaluation is crucial. This includes:

Ultrasound and MRI: To determine the size, number, and location of myomas

Blood tests: To check hemoglobin and coagulation profile

Fertility assessment: Especially for women planning future pregnancies

Surgical Technique
Performing laparoscopic myomectomy for a large deep intramural myoma requires advanced laparoscopic skills and meticulous planning:

Patient Positioning and Port Placement:

The patient is placed in a lithotomy position.

Multiple trocars are inserted to provide optimal access and maneuverability.

Uterine Manipulation:

A uterine manipulator helps in mobilizing the uterus to access the myoma.

Incision and Myoma Enucleation:

A small incision is made on the uterine surface overlying the myoma.

The myoma is carefully dissected and removed from the surrounding myometrium.

Hemostasis and Closure:

Electrocautery or advanced energy devices are used for hemostasis.

The uterine defect is meticulously sutured to preserve uterine integrity, crucial for future pregnancies.

Specimen Retrieval:

Myomas are removed using morcellation techniques or contained extraction to avoid tissue spillage.

Challenges

Large size may reduce working space within the abdomen.

Deep intramural location increases the risk of bleeding and uterine wall injury.

Requires advanced suturing skills to ensure uterine strength is maintained.

Postoperative Care

Early ambulation and pain management are encouraged.

Monitoring for bleeding or infection.

Follow-up imaging may be done to ensure complete removal.

Advantages Over Open Surgery
Laparoscopic myomectomy, even for large deep intramural myomas, offers:

Less blood loss

Reduced adhesion formation

Faster return to daily activities

Preservation of fertility

Conclusion
Laparoscopic myomectomy for large deep intramural myomas is a technically demanding but highly beneficial procedure when performed by experienced surgeons. With careful patient selection, meticulous technique, and advanced laparoscopic expertise, women can achieve excellent outcomes with minimal morbidity, faster recovery, and preservation of fertility.

For more information please contact: 
World Laparoscopy Hospital 
Cyber City, Gurugram, NCR DELHI
 INDIA 122002 
Phone & WhatsApp: +919811416838, + 91 9999677788