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Laparoscopic Extracorporeal Knot-Tying for Uterine Vessel Occlusion during Hysterectomy with Cervical Cerclage in Large Uteri

Laparoscopic Extracorporeal Knot-Tying for Uterine Vessel Occlusion during Hysterectomy with Cervical Cerclage in Large Uteri

Published on: September 12, 2025

Strategy for laparoscopic cervical myomectomy.

Shozo Matsuoka¹, Iwaho Kikuchi, Mari Kitade

¹Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan. smatuoka@juntendo.ac.jp

Journal of Minimally Invasive Gynecology

|March 23, 2010

Summary

Laparoscopic myomectomy for rare cervical myomas is feasible with a standardized surgical strategy. This approach ensures patient safety by carefully considering myoma location and proximity to surrounding organs.

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Area of Science:

Gynecology
Surgical Oncology

Background:

Cervical myomas are rare, comprising about 5% of all uterine myomas.
Their proximity to adjacent organs (bladder, ureter, rectum) necessitates modified surgical approaches compared to corpus myomas.
Previous literature lacks a clear outline for surgical treatment strategies for cervical myomas.

Purpose of the Study:

To investigate and define a surgical strategy for treating intracervical and extracervical myomas.
To establish a uniform operative procedure for laparoscopic myomectomy of cervical myomas.

Main Methods:

A retrospective review of 16 patients diagnosed with cervical myoma between January 2005 and April 2009.
All patients underwent laparoscopic myomectomy.

Main Results:

The mean operative time was 105.8 minutes, with a mean blood loss of 105 ml.
Mean specimen weight was 208.3 g.
Histopathological examination revealed leiomyoma in most cases, with one instance of atypical myoma.

Conclusions:

A safe and uniform surgical strategy for laparoscopic cervical myomectomy was developed.
Key elements include preoperative GnRH therapy, careful assessment of surrounding organs, temporary uterine artery occlusion, vasopressin use, strategic incision placement, and meticulous suturing to avoid dead space.