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Laparoscopic Management of Huge Cervical Myoma.
J Minim Invasive Gynecol. 2017 Mar - Apr; 24(3):345-346.JM

Abstract

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.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Acibadem University Atakent Hospital, İstanbul, Turkey. Electronic address: dr.ata1980@hotmail.com.Department of Obstetrics and Gynecology, Acibadem University Atakent Hospital, İstanbul, Turkey.Department of Obstetrics and Gynecology, Acibadem University Atakent Hospital, İstanbul, Turkey.

Pub Type(s)

Case Reports
Journal Article
Video-Audio Media

Language

eng

PubMed ID

27632929

Citation

Peker, Nuri, et al. "Laparoscopic Management of Huge Cervical Myoma." Journal of Minimally Invasive Gynecology, vol. 24, no. 3, 2017, pp. 345-346.
Peker N, Gündoğan S, Şendağ F. Laparoscopic Management of Huge Cervical Myoma. J Minim Invasive Gynecol. 2017;24(3):345-346.
Peker, N., Gündoğan, S., & Şendağ, F. (2017). Laparoscopic Management of Huge Cervical Myoma. Journal of Minimally Invasive Gynecology, 24(3), 345-346. https://doi.org/10.1016/j.jmig.2016.09.002
Peker N, Gündoğan S, Şendağ F. Laparoscopic Management of Huge Cervical Myoma. J Minim Invasive Gynecol. 2017 Mar - Apr;24(3):345-346. PubMed PMID: 27632929.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laparoscopic Management of Huge Cervical Myoma. AU - Peker,Nuri, AU - Gündoğan,Savaş, AU - Şendağ,Fatih, Y1 - 2016/09/12/ PY - 2016/08/14/received PY - 2016/09/03/accepted PY - 2016/9/17/pubmed PY - 2017/7/15/medline PY - 2016/9/17/entrez KW - Cervical myoma KW - Laparoscopy KW - Myomectomy SP - 345 EP - 346 JF - Journal of minimally invasive gynecology JO - J Minim Invasive Gynecol VL - 24 IS - 3 N2 - 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. SN - 1553-4669 UR - https://www.unboundmedicine.com/medline/citation/27632929/Laparoscopic_Management_of_Huge_Cervical_Myoma_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1553-4650(16)31042-1 DB - PRIME DP - Unbound Medicine ER -