Laparoscopic Management of Huge Cervical Myoma.

STUDY OBJECTIVE: To demonstrate the feasibility of laparoscopic management of a huge cervical myoma.

DESIGN: Step-by-step video demonstration of the surgical procedure (Canadian Task Force classification III-C).

SETTING: Uterine myoma is the most common benign neoplasm of the female reproductive tract, with an estimated incidence of 25% to 30% at reproductive age [1,2]. Patients generally have no symptoms; however, those with such symptoms as severe pelvic pain, heavy uterine bleeding, or infertility may be candidates for surgery. The traditional management is surgery; however, uterine artery embolization or hormonal therapy using a gonadotropin-releasing hormone agonist or a selective estrogen receptor modulator should be preferred as the medical approach. Surgical management should be performed via laparoscopy or laparotomy; however, the use of laparoscopic myomectomy is being debated for patients with huge myomas. Difficulties in the excision, removal, and repair of myometrial defects, increased operative time, and blood loss are factors keeping physicians away from laparoscopic myomectomy [1,2].

INTERVENTIONS: A 40-year-old gravida 0, para 0 woman was admitted to our clinic with complaints of chronic pelvic pain, dyspareunia, and infertility. Her health history was unremarkable. Ultrasonographic examination revealed a 14 × 10-cm myoma in the cervical region. On bimanual examination, an immobile solid mass originating from the uterine cervix and filling the pouch of Douglas was palpated. The patient was informed of the findings, and laparoscopic myomectomy was recommended because of her desire to preserve her fertility. Abdominopelvic examination revealed a huge myoma filling and enlarging the cervix. Myomectomy was performed using standard technique as described elsewhere. A transverse incision was made using a harmonic scalpel. The myoma was fixed with a corkscrew manipulator and enucleated. Once bleeding was controlled, the myoma bed was filled with Spongostan to prevent possible bleeding from leakage. Owing to the anatomic structure of the cervical region, the incision was closed in a monolayer with 0 Vicryl. Total intraoperative blood loss was 300 mL, the total weight of the myoma was 670 g, and the operation lasted approximately 140 minutes. The patient experienced no intraoperative complications. She was discharged on postoperative day 1 and did not exhibit any problems at follow-up. The final histopathological examination confirmed the diagnosis of uterine leiomyoma.

CONCLUSION: Laparoscopic management of huge myomas in difficult locations such as the cervical region seems to be a feasible and safe surgical option, especially in experienced hands.