Cystoscope-Assisted Laparoscopic Enucleation of a Large Progressive Bladder Leiomyoma

A bladder leiomyoma is a rare and benign bladder tumor. There are no established guidelines for the surgical treatment of this tumor. A transurethral approach for resection or surgical enucleation of the tumor is difficult, especially in patients with a large-sized leiomyoma. Therefore, a partial cystectomy is often indicated. In this case, we effectively performed a cystoscope-assisted laparoscopic enucleation of an intramural bladder leiomyoma. A 46-year-old female was incidentally found to have a large tumor on the left wall of her urinary bladder. The MRI and needle biopsy results confirmed that the tumor was a bladder leiomyoma. Despite its benign nature, the tumor was found to progressively increase in size in 6 months. Therefore, we chose to perform a laparoscopic enucleation of the tumor. Simultaneous intraoperative cystoscopy was utilized to observe the operative area from within the bladder, thus enabling us to perform the procedure relatively safely. Although there was a minor inadvertent injury to the bladder mucosa intraoperatively, the left ureteral orifice was preserved. As a result, the tumor was effectively enucleated. The postoperative course was uneventful, and no recurrence was observed at the 4-month follow-up. We effectively accomplished the cystoscope-assisted laparoscopic enucleation of a large-sized leiomyoma of the urinary bladder. Based on our experience, we suggest that this combined technique is better and safer than an independent laparoscopic surgery. In addition, this surgery is now technically feasible and may have other applications in robotic surgery in the future.