This video demonstrate Laparoscopic Myomectomy for Posterior Cervical Fibroid. Fibroid or Myomas are benign tumours composed partly of muscle and fibrous tissue. They seldom develop in the cervix, the lower part of the uterus as in this video. When posterior cervical fibroid grow, they are usually obliterating entire cul de sac. Cervical fibroids grow in the wall of the cervix and are difficult to remove without damaging the surrounding area. Most cervical myomas eventually cause symptoms of GIT or ureteric obstruction. The most common symptom may be irregular or heavy menstrual bleeding . Other symptoms include abdominal pain or pressure, changes in bladder and bowel patterns and, in some cases, infertility. Cervical myomas can block the flow of urine; women may have a hesitant start when urinating; dribble at the end of urination, and retain urine. Urinary tract infections are also more likely to develop. If cervical fibroids cause symptoms, they are surgically removed in a procedure called a Laparoscopic Myomectomy. After removal of fibroid suturing of the raw area is required. Depending upon the size of fibroid a long time is spend in morcellation of myoma.

Fibroids, medically known as leiomyomas, are benign tumors that develop in the muscular wall of the uterus. Among these, cervical fibroids are relatively rare, accounting for 1–5% of all uterine fibroids. Posterior cervical fibroids, located at the back of the cervix, present unique surgical challenges due to their proximity to vital structures such as the bladder, ureters, and rectum.

What is Laparoscopic Myomectomy?

Laparoscopic myomectomy is a minimally invasive surgical procedure used to remove fibroids while preserving the uterus. It involves the use of a laparoscope—a thin, lighted camera—inserted through small abdominal incisions. This technique offers several advantages over traditional open surgery, including:

• Smaller incisions and minimal scarring

• Reduced postoperative pain

• Faster recovery and shorter hospital stay

• Less blood loss

• Enhanced visualization of deep pelvic structures

Indications for Laparoscopic Removal of Posterior Cervical Fibroids

Surgery is typically recommended when fibroids cause symptoms such as:

• Heavy menstrual bleeding (menorrhagia)

• Pelvic pain or pressure

• Urinary frequency or retention

• Infertility or difficulty conceiving

Posterior cervical fibroids may also need removal if they distort the uterine anatomy or compress nearby organs.

Preoperative Preparation

Before surgery, the following steps are essential:

• Imaging: Ultrasound or MRI to evaluate the size, location, and relation to nearby structures

• Laboratory tests: Complete blood count, coagulation profile, and renal function tests

• Medical optimization: Correction of anemia if present and management of other medical conditions

• Counseling: Discussing risks, benefits, and alternatives with the patient

Surgical Technique: Step-by-Step

1. Anesthesia and Positioning
   The patient is placed under general anesthesia in a Trendelenburg position to allow optimal access to the pelvis.

2. Port Placement
   Several small abdominal incisions are made, usually:

   • One 10–12 mm umbilical port for the laparoscope

   • Two or three 5 mm ports for surgical instruments

3. Exposure and Assessment
   The posterior cervical fibroid is visualized. Adhesiolysis may be performed if previous surgeries have caused scar tissue.

4. Uterine Manipulation
   A uterine manipulator may be used to provide better access to the posterior aspect of the cervix.

5. Fibroid Enucleation

   • The fibroid is carefully dissected from the cervical tissue using energy devices (e.g., harmonic scalpel) or sharp dissection.

   • Hemostasis is meticulously maintained to prevent bleeding.

6. Defect Closure
   The myometrial defect is closed with intracorporeal suturing, ensuring restoration of uterine integrity.

7. Specimen Retrieval
   The fibroid is removed using morcellation or via a small incision, depending on its size.

8. Final Inspection and Closure
   The pelvis is inspected for hemostasis. Ports are removed, and incisions are closed.

Postoperative Care

• Early ambulation and gradual diet advancement

• Pain management with oral or IV analgesics

• Monitoring for complications such as bleeding, infection, or injury to nearby organs

• Follow-up imaging if needed

Advantages of Laparoscopic Approach

• Faster recovery compared to open surgery

• Reduced postoperative pain and hospital stay

• Lower risk of adhesions

• Better cosmetic outcome

Challenges and Considerations

• Posterior cervical fibroids are often deeply situated and close to vital structures.

• Skilled laparoscopic suturing is required for safe closure.

• Surgeons must be prepared for possible conversion to open surgery in case of complications.

Conclusion

Laparoscopic removal of posterior cervical fibroids is a safe and effective minimally invasive option for patients requiring surgical management. With careful preoperative planning, expert surgical technique, and postoperative care, patients can experience symptom relief with minimal disruption to daily life. This approach highlights the advances in modern gynecologic surgery, emphasizing patient safety, faster recovery, and optimal outcomes.

For more information log on to https://www.laparoscopyhospital.com/