Total Laparoscopic Hysterectomy and Bilateral Salpingectomy with Broad Ligament and Cervical Fibroids: Techniques

A 50 year old gravida 2 para 1011 with a history of abnormal uterine bleeding and dysmenorrhea secondary to uterine fibroids (including cervical and broad ligament fibroids) underwent a robotic-assisted total laparoscopic Hysterectomy, bilateral salpingectomy, cystoscopy, with insertion and removal of bilateral ureteral stents.

20 cc of Vasopressin was diluted in 60 cc of normal saline and injected into the uterus. The left round ligament was cauterized and the retroperitoneum was accessed. The left ureter was found to be anteriorly displaced to the level of the external iliac artery due to a broad ligament fibroid. The right round ligament was similarly cauterized and cut. The uterovesical peritoneum was dissected and the bladder flap was created. The ascending branches of the uterine arteries were coagulated and cut. Due to a 5 cm cervical fibroid, a supracervical hysterectomy was initially performed. Next, a cervical myoma enucleation was performed followed by a trachelectomy. Additional excess fibroid tissue was removed. A small Alexis retractor and Endocatch bag was inserted vaginally and the specimens were collected and removed. Pelvis was copious irrigated and suctioned with normal saline. The vaginal cuff was closed in two layers with multiple figure of eight sutures using 2-0 PDS.