Total Laparoscopic Hysterectomy for Fibroids

Symptoms

A 50 year old woman presented with a long history of heavy bleeding. She had recently noted the onset of abdominal swelling and was experiencing a pelvic pressure sensation.

Diagnosis

A pelvic ultrasound revealed a 10cm fundal fibroid and adenomyosis. This fibroid had been stable on the basis of serial ultrasound scans over 2 years.

Procedure

She subsequently underwent Total Laparoscopic Hysterectomy.

Laparoscopic view of large fibroid uterus and normal left ovary.

The ovaries were conserved at the patient's request. Normal right ovary seen. The ovarian ligament is divided.

The left round ligament is divided.

The large uterus was detached from the cervix to facilitate access - a modification of the standard technique because of the large fibroid.

The cervix is detached from the vaginal vault and then removed.

The vault is laparoscopically sutured. Two normal ovaries remain.