Minimally Invasive Laparoscopic Myomectomy for 3-kg Giant Uterine Leiomyomas: A Case Report

Abstract

Giant uterine leiomyomas, typically defined as fibroids larger than 10 cm or weighing more than 1,000 g, are uncommon and present significant surgical challenges due to increased vascularity, distorted pelvic anatomy, and the risk of massive hemorrhage. Traditionally, these tumors have been managed through laparotomy. However, advances in minimally invasive surgery have expanded the role of laparoscopic myomectomy in selected cases. Herein we report the case of a 29-year-old nulliparous woman who presented with progressive abdominal enlargement. Physical examination revealed a markedly enlarged uterus corresponding to a 36-week gestation. Magnetic resonance imaging demonstrated a giant anterior wall subserosal leiomyoma measuring 15.75 × 17.6 × 19.98 cm (FIGO type 6). The patient underwent laparoscopic myomectomy with pre-incisional vasopressin infiltration for hemorrhage control. A 20-cm fibroid was successfully enucleated through a fundal incision and removed using manual morcellation. The uterine defect was reconstructed with a two-layer closure. Operative time was 200 minutes, with an estimated blood loss of 1,600 mL requiring transfusion of two units of whole blood. The excised specimen weighed 3,175 g. The postoperative course was uneventful, and the patient was discharged on postoperative day two.