Posterior cervico-vaginal myomectomy: a laparoscopic technique

Background. Uterine myoma is considered the most common gynecological benign neoplasm occurring in 50–60% of women. Generally, the patients are asymptomatic, but almost a third of women with leiomyomas will require treatment due to symptoms such as heavy uterine bleeding, severe pelvic pain, bulk symptoms, dyspareunia or infertility. Cervical myomas are uncommon, with a prevalence of only 0.6%. Vaginal approach is the classical option for their removal, but when it is impossible, in some cases laparoscopy may be an alternative.
Objective. this article aims to describe a safe laparoscopic technique for a complete removal of a large cervico- vaginal myoma, the removal of which was impossible with a classical vaginal approach due to its size.
Description of the technique. In consideration of the myoma’s size, location, characteristics and the impossible vaginal approach, the patient was considered eligible for a laparoscopic myomectomy. Followings are the main surgical steps: Set up of surgical view of the intervention field; Vertical posterior colpotomy; Myoma’s peduncle identification and incision; Reduction of myoma’s size with power morcellation within the vagina; Extraction of the fibroid from the vagina to the peritoneal cavity through the colpotomy; Completion of the power morcellator and extraction of the whole specimen; Colporraphy; Peritoneal washing.
Conclusions. When the vaginal approach is not practicable, laparoscopic management of large myomas in difficult locations such as the cervico-vaginal region seems to be a feasible and a safe surgical option.

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