This video demonstrates Laparoscopic Myomectomy with Palmer's Point and Extraction by Colpotomy. This patient has a previous laparoscopy scar and intestinal adhesion. We performed laparoscopic myomectomy left side salpingo-oophorectomy for left side dermoid cyst and tubectomy for family planning. Extraction of tissue by colpotomy has the advantage that morcellator is not required and ends bag is also not required. Palmer's point is the most attractive site of access is when a previous laparostomy is there. Laparoscopic Myomectomy, sometimes also called fibroidectomy, refers to the minimal access to surgical removal of uterine leiomyomas, also known as fibroids. In contrast to a hysterectomy, the uterus remains preserved and the woman retains her reproductive potential. Here Salpingo-oophorectomy was performed for a dermoid cyst. Although ovarian cystectomy was possible patient opted for oophorectomy. She also wanted family planning so we did a tubectomy of the right side also.

Minimally invasive gynecological surgery has revolutionized the management of benign uterine and adnexal pathologies. Laparoscopic myomectomy combined with salpingo-oophorectomy is a safe and effective approach for women requiring fertility-preserving or definitive surgical treatment. The use of Palmer’s Point for laparoscopic entry and colpotomy for specimen extraction further enhances surgical safety and reduces abdominal wall morbidity, particularly in patients with previous surgeries or large pelvic masses.

This article discusses the indications, surgical technique, advantages, and outcomes of laparoscopic myomectomy and salpingo-oophorectomy performed via Palmer’s Point with specimen removal through colpotomy.

Indications

This combined laparoscopic approach is indicated in patients with:

Symptomatic uterine fibroids (menorrhagia, pelvic pain, infertility)

Ovarian cysts or tumors requiring salpingo-oophorectomy

Endometriosis with fibroids

Adnexal masses associated with uterine leiomyomas

Previous abdominal surgeries with suspected periumbilical adhesions

Desire to avoid large abdominal incisions

Preoperative Evaluation

A thorough preoperative assessment includes:

Pelvic ultrasonography or MRI to evaluate fibroid size, number, and adnexal pathology

Complete blood count and hormonal profile

Tumor markers (CA-125 when indicated)

Informed consent including fertility counseling and specimen extraction route

Bowel preparation when colpotomy is planned

Role of Palmer’s Point in Laparoscopy

Palmer’s Point is located 3 cm below the left costal margin in the midclavicular line. It is particularly useful in patients with:

Prior laparotomies

Umbilical hernias

Dense periumbilical adhesions

Large pelvic or uterine masses

Advantages of Palmer’s Point Entry

Reduced risk of bowel and vascular injury

Safer pneumoperitoneum creation

Better visualization in complex pelvic anatomy

Ideal for advanced gynecologic laparoscopy

Surgical Technique
1. Patient Positioning and Access

Patient placed in dorsal lithotomy position with steep Trendelenburg

Pneumoperitoneum established using Veress needle at Palmer’s Point

10-mm laparoscope introduced; accessory ports placed under vision

2. Laparoscopic Myomectomy

Vasopressin injected into the myometrium to reduce blood loss

Serosal incision made over fibroid using monopolar energy

Fibroid enucleated with traction and counter-traction

Myometrial defect closed in layers using barbed sutures

Hemostasis ensured

3. Laparoscopic Salpingo-Oophorectomy

Identification of ureter and pelvic landmarks

Coagulation and division of infundibulopelvic ligament

Transection of utero-ovarian ligament and fallopian tube

Specimen kept in pelvis for later extraction

4. Specimen Extraction by Colpotomy

Posterior colpotomy performed transvaginally

Fibroid and adnexal specimen delivered through vagina

Avoids need for morcellation or mini-laparotomy

Vaginal vault closed laparoscopically or vaginally

Advantages of Colpotomy for Specimen Retrieval

No additional abdominal incision

Eliminates risk of power morcellation

Reduced postoperative pain

Better cosmetic outcome

Shorter hospital stay

Lower risk of port-site hernia

Postoperative Care and Recovery

Early ambulation encouraged

Oral intake resumed within 6–8 hours

Analgesia requirement significantly reduced

Discharge typically within 24–48 hours

Return to routine activity in 1–2 weeks

Complications and Safety

When performed by experienced laparoscopic surgeons, complications are minimal and may include:

Bleeding

Infection

Vaginal cuff dehiscence (rare)

Injury to bowel or urinary tract (very rare)

Proper case selection and surgical expertise significantly reduce risks.

Conclusion

Laparoscopic myomectomy combined with salpingo-oophorectomy using Palmer’s Point entry and specimen extraction by colpotomy represents a safe, advanced, and patient-friendly minimally invasive gynecologic procedure. This approach minimizes surgical trauma, enhances safety in complex cases, and ensures faster recovery with excellent cosmetic and functional outcomes.

For more information:

World Laparoscopy Hospital
Cyber City, Gurugram, NCR Delhi
INDIA: +919811416838

World Laparoscopy Training Institute
Bld.No: 27, DHCC, Dubai
UAE: +971525857874

World Laparoscopy Training Institute
8320 Inv Dr, Tallahassee, Florida
USA : +1 321 250 7653