Laparoscopic myomectomy of a 34 weeks size myoma: ‘Exhausting but satisfying’

Abstract

Uterine leiomyomas are the most common benign tumors affecting reproductive age women. The symptomatic spectrum varies from large asymptomatic fibroids to smaller ones causing all sorts of menstrual problems. With the advent of minimally invasive surgery, laparoscopic myomectomy is the preferred approach to many of these myomas depending on the size, site and number as recommended by the standard bodies. Aims and objectives: To describe one of the largest myoma operated laparoscopically using conventional technique. Background: The size and type of myoma represent the best predictors of surgical difficulties and possible intraoperative complications. Intramural myomas > 8 cm and subserosal myomas > 12 cm are considered challenging to operate laparoscopically. Till date, to the best of our knowledge the largest myoma operated laparoscopically is around 30 cm. Case report: Authors report a case of 29 years old unmarried girl who presented with abdominal distention and on examination had a abdominopelvic mass of 34 weeks gravid uterus size. Ultrasound revealed a very large intramural fibroid arising from the left wall close to the fundus with a large submucosal component. An uneventful laparoscopic myomectomy was done. Conclusion: Laparoscopic myomectomy is surely a safe and attractive alternative to treat large myomas with less postoperative pain, shorter hospital stay and equivalent pregnancy outcomes. The authors believe that with required skills, experience, and improved technologies for tissue retrieval, the size may not be a limiting factor for laparoscopic myomectomies.