Tips and Tricks: Laparoscopic Hysterectomy with Large Cervical Fibroid

Study Objective This video describes various techniques to successfully perform a hysterectomy with a large cervical fibroid in a minimally invasive fashion. Design Case studies of two patients with large cervical fibroids who underwent definitive surgical management with total laparoscopic hysterectomy (TLH). Setting The video clips were taken in the operating room during planned procedures for two separate cases of patients undergoing TLH with cervical fibroids. Both patients were positioned in dorsal lithotomy with arms tucked. Patients or Participants The two patients each had 8-9 cm symptomatic cervical fibroids for which they desired definitive surgical management with hysterectomy. Their exams differed in length and accessibility of the cervix and in BMIs, as one patient had a shortened cervix with BMI of 28 and the other had an effaced and deviated cervix and BMI of 32. Interventions A set of techniques were employed to mitigate the challenge of TLH with a large cervical fibroid. This included pretreatment with Lupron, ureteral stent placement, ligation of uterine arteries at their origin, and different methods for completing colpotomy. Measurements and Main Results The cases exemplified how these techniques can be successful and how to use alternate approaches when unsuccessful. Both hysterectomies were successfully completed laparoscopically. Conclusion Cervical fibroids can present a challenge to accomplishing hysterectomy in a minimally invasive fashion. Successful laparoscopic hysterectomy can be performed with use of various techniques to reduce risk of bleeding and injury to nearby structures. More research is needed to help determine predictors for successful and unsuccessful applications of such techniques. This video describes various techniques to successfully perform a hysterectomy with a large cervical fibroid in a minimally invasive fashion. Case studies of two patients with large cervical fibroids who underwent definitive surgical management with total laparoscopic hysterectomy (TLH). The video clips were taken in the operating room during planned procedures for two separate cases of patients undergoing TLH with cervical fibroids. Both patients were positioned in dorsal lithotomy with arms tucked. The two patients each had 8-9 cm symptomatic cervical fibroids for which they desired definitive surgical management with hysterectomy. Their exams differed in length and accessibility of the cervix and in BMIs, as one patient had a shortened cervix with BMI of 28 and the other had an effaced and deviated cervix and BMI of 32. A set of techniques were employed to mitigate the challenge of TLH with a large cervical fibroid. This included pretreatment with Lupron, ureteral stent placement, ligation of uterine arteries at their origin, and different methods for completing colpotomy. The cases exemplified how these techniques can be successful and how to use alternate approaches when unsuccessful. Both hysterectomies were successfully completed laparoscopically. Cervical fibroids can present a challenge to accomplishing hysterectomy in a minimally invasive fashion. Successful laparoscopic hysterectomy can be performed with use of various techniques to reduce risk of bleeding and injury to nearby structures. More research is needed to help determine predictors for successful and unsuccessful applications of such techniques.