This Laparoscopic Video demonstrates the Laparoscopic Removal of a Large Posterior Cervical Fibroid. Compared to myomas that occur in the uterine corpus, cervical myomas are closer to other organs such as the bladder, ureter, and rectum, and the approach needs to be modified, as the organs that have to be considered differ depending on the location of the myoma. Surgical difficulties in laparoscopy associated with these cases are, poor access to the operative field, difficulty in suturing the repairs, increased blood loss, and distortion of the anatomy of the vital neighboring structures in the pelvic cavity.

Laparoscopic Myomectomy and Laparoscopic Hysterectomy have been advocated over traditional laparotomy for various benefits in the case of uterine leiomyoma. With the advances in laparoscopic techniques, almost all uterine myomas in the uterine corpus can be treated using laparoscopic myomectomy. However, the treatment of cervical myoma by laparoscopic operation remains crucial. It is essential to establish techniques for safety in operative laparoscopy, for different types of cervical myomas. Compared to myomas that occur in the uterine corpus, cervical myomas are closer to other organs such as the bladder, ureter, and rectum, and the approach needs to be modified, as the organs that have to be considered differ depending on the location of the myoma. Surgical Laparoscopic difficulties associated with these cases are, poor access to the operative field, difficulty in suturing the repairs, increased blood loss, and distortion of the anatomy of the vital neighboring structures in the pelvic cavity.

Fibroids, also known as uterine leiomyomas, are common benign tumors that develop in the uterus. While most fibroids are found in the uterine body, cervical fibroids are rare, accounting for only 1–2% of all fibroid cases. These fibroids, particularly when large and located posteriorly, can pose significant challenges in diagnosis and surgical management.
 
Laparoscopic surgery has emerged as a preferred minimally invasive technique for fibroid removal, offering reduced recovery time, minimal blood loss, and fewer complications compared to traditional open surgery. This article discusses the laparoscopic approach to removing a large posterior cervical fibroid, including indications, surgical technique, and postoperative care.
 
Challenges of Large Posterior Cervical Fibroids
Large posterior cervical fibroids can:
- Distort the normal anatomy of the uterus and cervix
- Compress adjacent structures such as the rectum and ureters
- Cause symptoms like pelvic pain, pressure, abnormal bleeding, and difficulty with urination or defecation
- Make surgical access more difficult due to their deep location in the pelvis
 
Preoperative Evaluation
A thorough preoperative assessment is crucial to determine the feasibility of laparoscopic removal. This includes:
- Pelvic Ultrasound & MRI: Helps assess the size, location, and relationship of the fibroid with adjacent structures.
- Blood Work: To evaluate hemoglobin levels and coagulation profile.
- Bowel & Bladder Preparation: May be necessary to improve surgical visibility and reduce the risk of complications.
 
Laparoscopic Surgical Technique
1. Patient Positioning & Anesthesia
- The patient is placed in the lithotomy position with steep Trendelenburg to enhance pelvic visualization.
- General anesthesia is administered.
 
2. Trocar Placement
- A primary trocar is inserted via the umbilicus for the laparoscope.
- Additional trocars are placed under direct vision to allow for surgical instrument access.
 
3. Identification & Dissection
- The posterior cervical fibroid is identified, and surrounding structures (ureters, bladder, rectum) are carefully dissected and protected.
 
4. Fibroid Enucleation
- The fibroid is excised using laparoscopic myomectomy techniques.
- Bleeding is controlled using bipolar electrocautery and suturing.
 
5. Specimen Retrieval
- The fibroid is morcellated (if necessary) or removed via a small incision to avoid excessive tissue trauma.
 
6. Closure & Hemostasis
- The defect is sutured laparoscopically to ensure proper healing.
- Hemostasis is confirmed before concluding the procedure.
 
Postoperative Care & Recovery
- Hospital Stay: Most patients are discharged within 24 hours.
- Pain Management: Mild pain can be controlled with oral analgesics.
- Activity Restrictions: Patients are advised to avoid heavy lifting and strenuous activities for a few weeks.
- Follow-Up: A post-surgical visit is scheduled to monitor recovery and assess for complications.
 
Conclusion
Laparoscopic removal of large posterior cervical fibroids is a technically demanding but feasible procedure in experienced hands. It offers significant advantages over open surgery, including faster recovery, less postoperative pain, and minimal scarring. With proper preoperative planning and advanced laparoscopic skills, successful outcomes can be achieved while minimizing risks.

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