Hand-assisted laparoscopy for megamyomectomy. A case report

In cases of uterine myomas of massive size, minimally invasive laparoscopic or laparoscopically assisted myomectomy techniques are not feasible alternatives to traditional laparotomy. This report introduces the use of hand-assisted laparoscopy, a novel approach that permits the insertion of the hand into the abdomen through a glove-sized incision while preserving the pneumoperitoneum, as an alternative to laparotomy for patients with massive myomas unsuitable for conventional laparoscopic myomectomy.

A 28-year-old nullipara requested minimally invasive myomectomy and fertility preservation for the treatment of a massively enlarged uterus reaching the level of the liver. Myomectomy was safely performed by hand-assisted laparoscopy using the Pneumo Sleeve System (Dexterity, Blue Bell, Pennsylvania), a 7.5-cm transverse suprapubic incision and a 1-cm umbilical laparoscopic incision. Surgery lasted 120 minutes, and the estimated blood loss was 250 mL. The total weight of the myomas was 3,120 g. The patient was discharged on the second postoperative day and had an uneventful recovery.

The successful outcome of this initial case suggests that hand-assisted laparoscopic myomectomy is a feasible and safe minimal-access option that could effectively replace routine laparotomy in patients with massive uterine enlargement.