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Laparotomic myomectomy for a huge cervical myoma in a young nulligravida woman: A case report and review of the literature
Abu Hashim, Hatem; Al Khiary, Moustafa & EL Rakhawy, Mohamed
Abstract
Background: A huge cervical myoma (rare) in a young woman is a nightmare of
every gynecologist owing to the associated technical challenges in performing a
myomectomy. Moreover, the 2014 US Food and Drug Administration prohibited power
morcellation during laparoscopic myomectomy due to the inadvertent spread of occult
malignancy and an increased risk of iatrogenic parasitic leiomyoma negatively affected
the overall rate of a minimally invasive surgery.
Case: This report described our experience with a case of a huge anterior
cervical myoma (473 gr) in a young nulligravida woman who successfully underwent
laparotomic myomectomy. After an initial diagnosis by Magnetic resonance imaging
(MRI), we performed preoperative ureteric catheterization. The myoma was enucleated
following the footsteps of Victor Bonney, the pioneer of myomectomy, combined
with simple additional steps. We did not use preoperative gonadotropin-releasing
hormone analog, intraoperative vasopressin injection, or uterine artery ligation. A 6-month follow-up MRI revealed an intact cervical canal in midline position with no
evidence of residual fibroid.
Conclusion: Based on our experience, the review of the relevant literature, and the US
Food and Drug Administration’s prohibition of power morcellation during laparoscopic
myomectomy, a laparotomic myomectomy for a huge cervical myoma still plays a vital
role in fertility preservation. We propose the mnemonic ”MUSIC” as a helpful guide for
a consistent strategy: M (preoperative MRI), U (prophylactic ureteric catheterization), S
(shell out the myoma following Bonney’s principles i.e. start-up and stay intracapsular),
I (immediate suction to clarify dead space) and C (close the cavity by spiraling stitch).
Keywords
Cervix; Fibroid; Leiomyoma; Myomectomy.
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