Description

Fibroids, also known as uterine leiomyomas, are among the most common benign tumors in women of reproductive age. While most fibroids remain small and asymptomatic, some grow to massive proportions, causing significant symptoms such as heavy menstrual bleeding, pelvic pain, urinary frequency, and infertility. The management of giant fibroids, especially those larger than 20 cm, is considered one of the most challenging procedures in gynecological surgery. At World Laparoscopy Hospital (WLH), Gurgaon, India, under the guidance of Prof. Dr. R. K. Mishra, a 24 cm giant posterior wall fibroid uterus was successfully managed through advanced laparoscopic surgery, showcasing the hospital’s expertise in handling highly complex cases with minimal access techniques. Case Overview A female patient presented with: A progressively enlarging abdominal mass Severe pelvic pain and pressure symptoms Heavy and irregular menstrual bleeding Difficulty in bladder emptying due to mass effect Ultrasound and MRI confirmed the presence of a 24 cm posterior wall intramural fibroid distorting the uterine anatomy and compressing the bladder and rectum. Traditionally, such a large fibroid would be managed by open abdominal surgery; however, the patient was counseled for laparoscopic management at World Laparoscopy Hospital, given its numerous benefits. Surgical Challenges Performing laparoscopic surgery on a uterus enlarged by a 24 cm fibroid is highly demanding due to: Limited intra-abdominal working space Distorted anatomy and displacement of surrounding organs High risk of excessive bleeding Difficulty in specimen retrieval Advanced Laparoscopic Technique at WLH At World Laparoscopy Hospital, surgeons adopted a stepwise advanced laparoscopic approach: Port Placement and Abdominal Access – Special techniques were used to create safe entry despite limited space due to the large mass. Vasopressin Injection – To minimize blood loss, vasopressin was injected into the myometrium around the fibroid. Meticulous Myomectomy – The giant fibroid was carefully enucleated from the posterior uterine wall while preserving the surrounding uterine tissue. Hemostasis and Suturing – The uterine defect was closed using advanced laparoscopic suturing skills, ensuring structural strength and minimizing adhesion risk. Specimen Retrieval – The fibroid was removed using in-bag power morcellation, ensuring complete and safe extraction.