Navigating Through Technical Difficulties in Operating Massive Cervical Fibroid-A Case Report and Narrative Review

Total abdominal hysterectomy (TAH), commonly referred to as extrafascial hysterectomy, is widely used in standard gynecological practice. However, hysterectomy performed in cervical leiomyoma presents greater challenges and pitfalls that require a modified approach. This case report wishes to highlight the importance of anatomical identification and the application of the intrafascial approach of hysterectomy.

A 57-year-old multiparous woman was admitted with a significant abdominal mass. During the physical examination, a large globular firm mass, corresponding to approximately 24 weeks of pregnancy, was identified. Ultrasonography revealed a cervical fibroid, and subsequent biopsy confirmed this diagnosis. We decided to perform intrafascial hysterectomy. Intraoperatively, the cervical fibroid was found 20 × 16 cm in size, whereas the uterus measured 14 × 14 cm. Pathological examination confirmed the presence of leiomyoma and endocervicosis of the cervix.

Cervical fibroids present considerable challenges during surgical procedures due to alterations in uterine anatomy, which can affect the ureter's danger zone. The application of the intrafascial technique in hysterectomy is essential for minimizing the risk to the ureters and for preserving the cervical ring.