Myomectomy for a large uterine fibroid via mini-laparotomy: a step-by-step video tutorial

Objective: To provide a video tutorial on myomectomy via mini-laparotomy in women with large uterine fibroids.

Design: Stepwise demonstration of the technique with narrated video footage.

Setting: Uterine fibroids represent the most common benign gynecologic disease, and myomectomy is a frequent reproductive surgery aiming to preserve or improve fertility. Abdominal and laparoscopic myomectomy are common treatments, but over the last decades, laparoscopy has become the preferred surgical approach because it provides significant advantages, such as shorter recovery time and a lower overall risk of complications. However, removal of large fibroids by laparoscopy is often technically challenging or even impossible.

Patient(s): A 29-year-old woman presenting with urinary frequency and lower abdominal pressure due to a 14-cm diameter FIGO type 4 uterine fibroid in the anterior uterine wall.

Intervention(s): Myomectomy via mini-laparotomy using a 4-cm transverse skin incision and morcellation with a scalpel using an atraumatic circular self-retaining wound retractor.

Main outcome measure(s): Mini-laparotomy represents a safe and simple approach combining the benefits of laparoscopy, such as reduced postoperative pain, reduced morbidity, and shorter hospitalization time, and the benefits of laparotomy, such as shorter duration of surgery, cost-effectiveness, and no need for advanced laparoscopic skills.

Result(s): Mini-laparotomy can provide preferable cosmesis compared with alternative approaches.

Conclusion(s): Mini-laparotomy represents an alternative minimally-invasive approach for large uterine fibroids, resulting in good overall outcome and no need for special surgical skills or equipment including power-morcellators. With this video, we aim to expedite the clinical learning curve of this technique and believe that selected patients desiring fertility could benefit from its application on a broader scale in the future.