Description

Watch this advanced gynecological surgical demonstration from World Laparoscopy Hospital (WLH) featuring laparoscopic myomectomy for multiple large intramural uterine fibroids. This procedure demonstrates the surgical principles involved in removing multiple fibroids through minimally invasive techniques while aiming to preserve the uterus and maintain healthy surrounding myometrial tissue. Multiple large intramural fibroids can make laparoscopic myomectomy technically challenging. These fibroids develop within the muscular wall of the uterus and may cause heavy menstrual bleeding, pelvic pressure, abdominal discomfort, and reproductive difficulties. When several large fibroids are present, the surgeon must carefully plan the sequence of removal, identify the correct tissue planes, control bleeding, and reconstruct the uterine wall securely. This video provides an educational overview of the important steps involved in laparoscopic myomectomy, including abdominal access, pelvic assessment, fibroid localization, uterine incision, enucleation, hemostasis, multilayer suturing, and specimen retrieval. Understanding Multiple Large Intramural Fibroids Uterine fibroids, also known as leiomyomas, are benign growths arising from the smooth muscle of the uterus. Intramural fibroids are located within the uterine muscular wall and can vary considerably in size, number, and depth. When multiple large intramural fibroids are present, they may enlarge or distort the uterus and affect its normal contractility. Depending on their location and size, symptoms may include: Heavy or prolonged menstrual bleeding. Pelvic pain, pressure, or a feeling of abdominal heaviness. Frequent urination due to pressure on the urinary bladder. Constipation or bowel pressure in selected cases. Anemia resulting from excessive menstrual blood loss. Fertility-related concerns in some patients. Not every fibroid requires surgery. Treatment depends on symptoms, fibroid characteristics, age, reproductive plans, and the patient's overall clinical condition. What Is Laparoscopic Myomectomy? Laparoscopic myomectomy is a minimally invasive operation in which uterine fibroids are removed through small abdominal incisions using a camera and specialized instruments. Unlike hysterectomy, myomectomy aims to remove the fibroids while retaining the uterus. It may be considered for women who have symptomatic fibroids and wish to preserve their uterus, including some women planning future pregnancy. However, suitability depends on the number, size, location, and depth of the fibroids, as well as the surgeon's assessment. In cases involving multiple large intramural fibroids, careful operative planning is essential because removing several fibroids can create multiple defects in the uterine muscle that require secure reconstruction.