This video demonstrates laparoscopic surgery for Round Ligament Fibroid Removal by Two Port by Dr. R.K. Mishra at World Laparoscopy Hospital.

Round ligament fibroids occur in the extraperitoneal portion of the ligament and are mostly seen to the right of the adnexa for still unknown reasons. These fibroids usually resemble an inguinal hernia, lymphadenopathies, ovarian cysts, and other pelvic masses because of the localization. There are several cases reporting management of round ligament fibroids via laparotomy in the literature. However, with recent advancements in laparoscopic surgery, laparoscopic approaches are more feasible and advantageous than laparotomy, with the additional benefits of a shorter hospital stay and recovery periods.

The diagnosis of round ligament fibroids is challenging. The presentation may be asymptomatic but must be kept in mind in the differential diagnosis of adnexal torsions. Laparoscopy can be the first choice where operation room settings are available.

Fibroids, also known as leiomyomas, are benign tumors of the uterus that can develop in various locations. One rare but clinically significant type is the round ligament fibroid. The round ligament, a structure that helps support the uterus, can occasionally harbor fibroids, leading to pain, swelling, or pressure symptoms. Laparoscopic surgery has revolutionized the treatment of such fibroids, offering minimal invasiveness, faster recovery, and excellent cosmetic results.

Two-Port Laparoscopic Approach
Traditionally, laparoscopic fibroid removal involves three or more ports. However, the two-port laparoscopic technique is an advanced minimally invasive approach that reduces surgical trauma, improves cosmetic outcomes, and shortens recovery time.

Preoperative Preparation

Detailed imaging (ultrasound or MRI) to localize the fibroid

Routine blood work and pre-anesthetic evaluation

Bowel preparation if necessary

Patient counseling regarding risks, benefits, and recovery

Surgical Technique

Port Placement:

One 10 mm umbilical port for the laparoscope

One 5 mm accessory port in the lower abdomen for instruments

Identification of Fibroid:

The round ligament fibroid is visualized as a firm, well-circumscribed mass

Careful dissection is done to avoid injury to nearby structures

Excision of Fibroid:

Using atraumatic graspers and energy devices, the fibroid is carefully dissected from the ligament

Hemostasis is achieved with bipolar cautery or advanced energy devices

Specimen Retrieval:

The fibroid is retrieved through the umbilical port, either intact or after morcellation if needed

Closure:

Ports are removed, and fascia and skin are closed with minimal suturing

No drain is usually required

Advantages of Two-Port Technique

Reduced postoperative pain

Shorter hospital stay

Minimal scarring

Faster return to daily activities

Lower risk of infection and port-site complications

Postoperative Care

Early mobilization and oral intake

Pain managed with oral analgesics

Follow-up imaging if needed to ensure complete removal

Conclusion
Laparoscopic removal of round ligament fibroids using the two-port technique is a safe, effective, and minimally invasive option. With experienced hands, it provides excellent surgical outcomes, rapid recovery, and improved patient satisfaction. Surgeons trained in advanced laparoscopy can adopt this technique for selected patients, enhancing the overall quality of care in gynecological surgery.