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Navigating Through Technical Difficulties in Operating Massive Cervical Fibroid-A Case Report and Narrative Review
Alfonsus Zeus Suryawan1, Evita Laras Dewayanti1, Dini Pusianawati1
1Department of Obstetrics and Gynecology, Padjadjaran University, Hasan Sadikin General Hospital, Bandung, West Java, Indonesia, unpad.ac.id.
Case Reports in Obstetrics and Gynecology
|January 30, 2026
Summary
Total abdominal hysterectomy (TAH) is standard, but cervical leiomyomas require a modified intrafascial approach. This technique is crucial for anatomical identification and minimizing ureter risks during hysterectomy for cervical fibroids.
Area of Science:
- Gynecologic Surgery
- Surgical Oncology
- Reproductive Medicine
Background:
- Total abdominal hysterectomy (TAH) is a common gynecological procedure.
- Cervical leiomyomas pose unique surgical challenges due to altered anatomy.
- Standard hysterectomy techniques may increase risks in cases of cervical fibroids.
Purpose of the Study:
- To highlight the challenges of hysterectomy in the presence of cervical leiomyoma.
- To emphasize the importance of anatomical identification during surgery.
- To advocate for the intrafascial approach in managing cervical fibroids.
Main Methods:
- Case report of a 57-year-old multiparous woman with a large cervical fibroid.
- Diagnosis confirmed via ultrasonography and biopsy.
- Surgical intervention using the intrafascial hysterectomy technique.
Main Results:
- A large cervical fibroid (20 x 16 cm) was identified intraoperatively.
- The uterus measured 14 x 14 cm.
- Pathological examination confirmed leiomyoma and endocervicosis of the cervix.
Conclusions:
- Cervical fibroids significantly alter uterine anatomy, increasing surgical risks, particularly to the ureters.
- The intrafascial hysterectomy technique is essential for minimizing ureteral injury.
- Preservation of the cervical ring is a key benefit of the intrafascial approach in these cases.
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