Total Laparoscopic Hysterectomy without Mini-Laparotomy for a 7060g Myomatous Uterus with Cystic Degeneration.

Study Objective Uterine leiomyomas are the most common benign gynecological soft tissue tumors in women. Although the laparoscopic approach is a standard treatment option, it is more difficult to achieve minimally invasive hysterectomy in cases with giant myomatous uteri. The laparoscopic removal of a myomatous uterus over 7000g without mini-laparotomy has not been reported in literature. Here we report the surgical challenges in the case of a patient with a 7060g myomatous uterus with cystic degeneration. Design Stepwise demonstration of the technique with narrated video footage. Setting An urban general hospital. Patients or Participants A 54-year-old woman was referred to our department for treatment for a huge fibromatous uterus. She suffered pelvic pressure and abdominal distension for several months. A magnetic resonance imaging scan showed a cystic-degenerated fibromatous uterus measuring 27.5cm × 21.3cm × 29.5cm with no suggestion of malignancy. Interventions We performed a laparoscopic hysterectomy and bilateral salpingo-oophorectomy. Intraoperatively, we aspirated the contents of the degenerative cyst of the uterus for mass reduction, and then closed the cyst hole by suturing to prevent leakage of the contents. This was followed by our usual surgical steps. We removed the specimen transvaginally. The total weight of the uterus removed was 7060g, including 5300g of cyst contents. The operation lasted for 79 minutes, and the intraoperative blood loss was 50g. No intraoperative complications occurred. Measurements and Main Results The histology confirmed the diagnosis of leiomyoma. The patient's postoperative course was unremarkable with no complications. Conclusion Uterus size has been considered a barrier to the use of laparoscopy for hysterectomy. We believe this is the first reported laparoscopic hysterectomy without mini-laparotomy in a patient with a giant uterus, over 7000g. Though appropriate case selection is necessary, this case demonstrates the efficiency and safety of laparoscopic hysterectomy for giant myomatous uterus cases.