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Spontaneous nonpuerperal uterine inversion is an exceedingly rare gynecological event. When it occurs, it is often due to an intrauterine polypoid mass attached to the uterine fundus, eventually pulling the uterus inside out over time as the mass increases in size. We present a case of nonpuerperal uterine inversion in a 32-year-old female who presented with heavy vaginal bleeding and vaginal protrusion of a fleshy mass. A clinical diagnosis of chronic uterine inversion due to a pedunculated submucous fibroid was made and was surgically managed with a vaginal myomectomy combined with an exploratory laparotomy and surgical reduction under general anesthesia. Good clinical acumen and surgical skills are invaluable for accurate diagnosis and appropriate treatment of nonpuerperal uterine inversion.

Cervical myomas are benign tumors originating from cervical muscle tissue with a very rare incidence of only about 8% of all myomas. The surgical approach depends on the position of cervical myoma. This case report discusses a 44-year-old woman who complained of a lump discharge from her birth canal 6 months ago, and currently discharging from her vagina. We performed vaginal myomectomy, and the cervical myoma measuring 8 × 8 × 6 cm with solid consistency was removed. We continued with total vaginal hysterectomy. Post-operative recovery was progressing well. The histopathology report was consistent with leiomyoma. Large prolapsed cervical myoma can be disturbing and discomforting for many patients. It is relatively rare and can be successfully removed vaginally with minimal morbidity. J Med Cases. 2021;12(7):288-290 doi: https://doi.org/10.14740/jmc3698

Resume Objectifs Les objectifs de cette serie sont d’evaluer les resultats de la myomectomie par voie vaginale et d’evaluer le risque adherentiel post operatoire. Methodes Il s’agissait d’une etude prospective observationnelle menee sur cinquante patientes. Toutes les patientes ont beneficie d’une myomectomie vaginale, suivi six mois apres d’une cœlioscopie pour evaluer et traiter les adherences post operatoires. Resultats Les myomectomies ont ete realisees via une colpotomie anterieure, posterieure et mixte dans respectivement 42 %, 54 % et 4 % des cas. La laparoconversion etait necessaire dans trois cas (6 %). La cœlioscopie d’evaluation a ete realisee chez 24 patientes (48 %). Les adherences etaient presentes dans 14cas (58,33 %). Aucune atteinte des annexes n’a ete relevee. Conclusion La myomectomie vaginale etait realisable, non limitee a la myomectomie unique ce qui est en accord avec des series deja publiees. Le risque adherentiel postoperatoire parait plus faible et ne concerne pas les annexes, mais ceci necessite d’etre confirme.

Leiomyoma of the uterus, also called fibroids, are common in women. In this case report, we describe the case of a nulliparous woman with a large, prolapsed submucous uterine leiomyoma of 10 × 11 cm was vaginally impacted. The aim is to highlight the challenges in managing such uncommon clinical scenario focusing on the factors predicting the success of vaginal myomectomy including the size of the myoma but also the role of vaginal laxity to allow the steps of devascularization, detachment, and removal of the myoma. We also describe the preoperative and intraoperative methods that can be used to minimize intraoperative blood loss and enhance the safety and feasibility of the surgical procedure. Gonadotropin therapy was not applicable in our patient, and other treatments were also unavailable such as temporary ligation of uterine arteries, while others were unsuccessful like devascularization by hysteroscopy, twisting, and ligation of the pedicle. The final resort used in our case was morcellation of the myoma with intact pedicle, which should be attempted by experienced gynecologic surgeons only.

Introduction: Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) is an emerging technique in the area of minimally invasive surgery. Vaginal leiomyoma is a rare benign tumor, with only a few cases being reported in the literature. we demonstrate a novel approach for excision of a vaginal leiomyoma via vNOTES. To ensure reproducibility and replicability akin to a standardized procedure, we have provided a step-by-step video description of the use of vNOTES for upper anterior vaginal myomectomy. Patient concerns: A 35-year-old female (G2P0A2) presented with a tumor in the upper anterior vaginal wall, which gradually increased in size. Diagnosis: A vaginal examination revealed a swollen area approximately 3-cm in diameter on the upper anterior vaginal wall. The swelling was mobile and solid. All other vitals were normal. Transvaginal ultrasound detected a 3.0 × 3.4 cm hypoechogenic mass on the superior vaginal wall, and a preoperative diagnosis of the vaginal tumor was confirmed. Interventions: The upper vaginal leiomyoma treated using transvaginal natural orifice transluminal endoscopic surgery. Outcomes: The procedure lasted for 20 min, and the postoperative course was uneventful. Conclusions: vNOTES can be a promising alternative to traditional vaginal surgery for upper vaginal disease due to advantages such as excellent exposure, easy access and precise suturing. However, more studies are needed to assess its long-term efficacy.

The prevalence of clinically symptomatic cervical leiomyomas in pregnancy is lower than 0.1%. Surgical intervention is necessary in extremely rare cases and only few are described in the literature. This study presents a case of successful vaginal myomectomy in the 13 th week of pregnancy followed by a delivery of a healthy neonate in term by cesarean section.

Prolapsed submucosal myomas during pregnancy are uncommon, and few cases of patients undergoing vaginal myomectomy during pregnancy have been reported. In our center, a 13 weeks pregnant patient with prolapsed cervical myoma was diagnosed. Because of intermittent vaginal bleeding, surgery was scheduled at 13 weeks and 5 days of pregnancy. A vaginal myomectomy was performed. The postoperative course was uneventful. Cervical leiomyomas and prolapsed submucosal leiomyomas in pregnancy are rare clinical entities, and the literature is comprised of only case reports. We reviewed the current literature in regard to prolapsed cervical leiomyomas in pregnancy and provide an updated vision of the literature.

Study Objective To demonstrate the importance of resecting large intracavitary fibroids using a combination of minimally invasive techniques, particularly vaginal morcellation and hysteroscopy. Design Video case presentation. Setting A major urban teaching institution. In the operating room, the patient was placed in dorsal lithotomy. Patients or Participants 22-year-old G0 with a 12 cm intracavitary fibroid causing heavy vaginal bleeding with a starting hemoglobin of 7.3 g/dL. She was a Jehovah's Witness and would only accept a blood transfusion in the case of an absolute emergency. Interventions The patient was admitted to the hospital and underwent a gel foam uterine artery embolization preoperatively. She was also given preoperative misoprostol and tranexamic acid. She underwent a transvaginal myomectomy with hysteroscopic assistance. Measurements and Main Results Complete resection of the large intracavitary fibroid was achieved using the combined vaginal and hysteroscopic myomectomy techniques demonstrated in this video. Minimal blood loss, decreased length of stay, reduced recovery time, and decreased need for future surgery were also achieved in this case. Conclusion The preoperative blood loss reduction strategies and combined vaginal and hysteroscopic surgical approaches minimized blood loss, hospital stay, recovery time, and need for future surgery in this patient. Additionally, a blood transfusion was avoided in a patient who is Jehovah's Witness. This video demonstrates that even large intracavitary fibroids can be resected using minimally invasive techniques.

Leiomyomas can develop after hysterectomy and, when located in the bladder, can result in voiding dysfunction and incontinence.Fifty years after a hysterectomy, a 77-year-old woman presented with a 1-year history of urinary retention requiring self-catheterization and bothersome urinary incontinence. Multiple imaging modalities demonstrated a well-circumscribed 2-cm mass abutting the bladder beneath the trigone. After ureteral stent placement, we excised the nonpalpable mass using ultrasound guidance. We identified a 1.5-cm incidental cystomy and repaired it in layers. After the repair, we placed a suprapubic catheter. Pathologic examination of the mass revealed a leiomyoma. Postoperatively, we confirmed the integrity of the bladder, removed the ureteral stents, and reviewed postvoid residuals, which were minimal before removing the suprapubic catheter. Six weeks after her operation, the patient voided spontaneously with significant improvement of her urinary incontinence.Vaginal resection with ureteral stenting represents a safe surgical approach for resection of a symptomatic, benign bladder mass.

Study Objective The aim of our study is to perfect technique of vaginal myomectomy and evaluate the safety and efficacy of combined minilaparoscopic and vaginal approach through anterior and posterior cul-de-sac. Design Prospective study. Setting Department of Gynecology, City Hospital. Patients or Participants All women with reproductive plans and symptomatic subserous or intramural fibroids from 4 cm to 7 cm in diameter treated with minilaparoscopic assisted vaginal myomectomy (MiniLAVM) in our department were prospectively followed. Interventions Minilaparoscopic assisted vaginal myomectomy. Measurements and Main Results 19 patients entered the study between January 2016 and December 2018. 17 patients had MiniLAVM through the posterior cul-de-sac and 2 through the anterior one. Age range 31–47 years, mean 42.4 ±5.8 years; parity range 0–4, mean 2.1 ± 1.6). Two patients had a prior history of Cesarean sections, 2 patients had undergone pelvic surgery. The mean duration of hospital stay was 3.2±1.5 days (range, 2–4 days). Mean amount of blood loss was 125±87.2мл (range, 20–550 ml). Mean duration of surgery was 106.49±38.2 мин (range, 60–140 minutes). Mean total myoma size was 7.1 ± 1.4 cm (range, 4. 5–7 cm). The mean number of myomata removed was 1.4 ± 1.1. None of the cases were converted to laparotomy. All uterine and colpotomic defects were repaired vaginally. None of the cases required a blood transfusion. No major complications occurred. Two patients had full term labor, one of them underwent a Cesarean section. Conclusion The MiniLAVM procedure offers advantages over both laparoscopic and abdominal myomectomy such as digital palpation, direct suturing, no morcelation needed, good visualisation for evaluation of abdominal organs and appropriate control for place of surgery, the application of an antiadhesive barrier, minimallyinvasiveness with good cosmetic effect. This is a preliminary study involving a small number of patients; we believe a larger study will be required to further investigate the efficiency and safety of MiniLAVM.

Cervical leiomyoma consists 1-2% of all leiomyoma and myxoid degeneration of cervical fibroid is very rare. We present an old neglected case of huge necrotic cervical leiomyoma presenting with prolapse of mass and pelvic organs in a woman with multiple co-morbidities. Early management was necessary for improving her quality of life and controlling blood sugar. In lack of fitness for anaesthesia we performed her vaginal myomectomy under Intravenous Sedation. Prolapse was reducible and in absence of septic foci blood sugar profile improved. Vaginal myomectomy is a safe and quick procedure with least surgical morbidity and should be considered in cervical fibroids.

Objective Cases of prolapsed myoma in which pregnancy was carried to full term or near term after vaginal myomectomy are very rare. Previously, only two such cases have been reported. In addition, both those patients had a pedunculated leiomyoma, which could be treated by twisting or clamping. Here, we report a case of a patient who was able to carry her pregnancy to term despite vaginal myomectomy for semipedunculated myoma at 13 weeks of pregnancy. Study Design This study is a case presentation. Results The myoma nucleus was removed by making an incision on the surface of the mass. Systemic and transvaginal antibiotics were prescribed after the surgery. Uterine contractions, short cervix, or cervical funneling was not observed in the remaining duration of pregnancy. Conclusion While performing myomectomy during pregnancy, removal of the myoma nucleus is safer than twisting. In addition, postoperative administration of local or systemic antibiotic agents does not adversely affect pregnancy.

Video Objective To demonstrate a minimally invasive technique used on approaching of a large vaginal fibroid. Setting A 30-year-old woman with important transvaginal bleeding which started 6 months ago. A MRI was perfomed and showed the presence of an heterogeneous image with slightly lobed contours, located on the upper third of the right vaginal wall, measuring 6,4 × 6,4 × 5,9cm, subsequentaly. Interventions The patient was admitted to a terciary hospital of the Fortaleza - Brazil (Cesar Cals Hospital) for a video- assisted vaginal myomectomy due to a large vaginal fibroid as described by a previous MRI. Intraoperatively, with the aid of a laparoscopy was verified that the fibroid extended deep into the pararectal and parametrial spaces, being necessary to approach this spaces to identify noble structures, such as ureter and pelvic nerves. Surgical procedure was successfully completed and the patient was discharged on the day after surgery. Conclusion Vaginal fibroids are a rare condition and commonly need a vaginal approach surgery. However, in some cases it requires both abdominal and vaginal approach when de fibroids are so extensive and infiltrative. This video uses a particularly challenging case to demonstrate a laparoscopic assisted vaginal myomectomy as a safe procedure for cases like this.

Video Objective To show a further application for the "Single Port/Pneumovagina technique". Setting 35 year old nulligravida who complained of dyspareunia. On pelvic examination she had a 3 cm vaginal leiomyoma, lateral and posterior to the cervix. Pelvic ultrasound showed no communication with the uterus or cervix. Interventions Under spinal anesthesia she underwent a vaginal myomectomy using a single port device to create a pneumovagina. 4 ports were inserted to the device´s cap (0° optics, bipolar, scissors and myoma screw). Pneumovagina was created with a 12mmHg Co2 pressure and 5l/min flow. Conclusion we shower a further application for the "Single Port/Pneumovagina technique", which we had previously described for the treatment of vaginal septums.

INTRODUCTION: The reported prevalence of fibroid in pregnancy is 10.7% (1). Fibroids necessitating surgery in pregnancy is rare and myomectomy in pregnancy has been reported to be successful in a few series (2,3). Myomectomy may be warranted when there is associated pain not relieved with conservative measures, haemorrhage necessitating transfusion or when degeneration of the fibroid leads to infection. There are only a few reports in the literature outlining vaginal myomectomy of a cervical or prolapsed submucous fibroid (4,5).

Non-puerperal acute inversion of uterus is a rare complication that occurs as a complication of intra uterine tumors, especially big sub mucous leiomyoma. It is so rare that many gynecologists may not encounter such a case in their life time professional carrier. This condition causes severe pain, vaginal bleeding and shock. Management consists of manual reposition through cervical ring or surgical corrective measures. We report a case of acute uterine inversion in a 42 years lady due to big sub mucous fibroid. This case was initially managed by vaginal myomectomy then uterus was repositioned by Haultain’s technique, which was abdominal hysterectomy. DOI: http://dx.doi.org/10.3126/njog.v9i1.11190 NJOG 2014 Jan-Jun; 2(1):58-60

The objective of this literature review was to evaluate the results obtained at vaginal myomectomy. The databases consulted were Medline, Cochrane Library, National Guideline Clearinghouse, and Health Technology Assessment Database. Keywords used for research were colpotomy, myomectomy, and vaginal myomectomy, and then abdominal myomectomy, laparoscopic-assisted vaginal myomectomy, and laparoscopic myomectomy. Eight case series and 2 case reports were analyzed, and included 372 patients. Reported rates of conversion to laparotomy during the operation ranged from 0% to 17.6%. The most frequently described risk factors for conversion to laparotomy were location of the myoma in the fundus and a large volume of myoma to be extracted, although no maximum threshold size can be defined. Performing laparoscopy first does not seem to limit the risk. Reported rates of transfusion during the operation ranged from 0% to 40%. Several cases of pelvic abscess have been described, with reported frequency of 2.2% to 5.7%. Authors mentioned the role of the vaginal drain that is inserted at the end of the procedure. No specific studies have been performed on long-term effectiveness, postoperative adhesions, integrity of the scar, or subsequent fertility. There are no good controlled studies of this technique. Feasibility seems to be acceptable, although the risk of pelvic infection in the postoperative period may be increased. Long-term effectiveness and safety were not assessed. A vaginal approach may be considered an alternative to laparotomy or laparoscopy in surgery to treat accessible myomas, and seems to be the simplest method.

Background: Uterine fibroids are benign tumors of the uterus and those located beneath the uterine mucosa may present as prolapsed fibroid in the vagina. Prolapsed submucous fibroid associated with complete uterovaginal prolapse is however uncommon. Case: A case of irreducible complete utero-vaginal and infected sub-mucous fibroid prolapse, in a 45-year-old grandmultiparous woman, is reported. Bed rest and antibiotics failed to relief edema and infection of the vault. Vaginal myomectomy, followed by interval vaginal hysterectomy, and pelvic floor repair a week later resulted in a satisfactory outcome.Keywords: Fibroid, Interval vaginal hysterectomy, Utero‑vaginal prolapse, Vaginal myomectomy

Cervical Myomatous Polyp Leading to Third Degree Uterine Prolapse in Virgin Lady with Intact Hymen We are reporting a rare case of cervical myomatous polyp leading to third degree utero-vaginal prolapsed in a 40 years old virgin lady with intact hymenal ring. Vaginal myomectomy was performed and the prolapse reduced gradually and spontaneously within a span of three months. The hymen remained intact after the procedure. There are reports of prolapse occurring due to cervical myoma in multiparous women but no such case in a virgin has been reported according to our knowledge after extensive search in Pubmed and Google. Such cases require conservative surgical approach as the tone of the tissues may suffice for reverting back the prolapse.

This pilot study assessed the feasibility and complications of a combined laparoscopic and vaginal approach through the posterior colpotomy in cases of fundal or posterior wall uterine fibroids. Twenty-four women with single symptomatic fibroids (size 5–8 cm) were prospectively assigned to undergo either laparoscopic-assisted vaginal myomectomy (LAVM; n=12) or laparoscopic myomectomy (LM; n=12). Surgical characteristics, hospital stay, and complications were analyzed. Blood samples for assay of tissue markers [C-reactive protein (CRP), creatine kinase (CK), and white blood cell count] and hemoglobin were taken preoperatively and on the 1st and 3rd postoperative days. There were no differences between the two groups with regard to demographic characteristics. The mean operating time was shorter in the LAVM group (64.44±17.4 min vs. 89.00±23.4 min, P

Vaginal myomectomy is an uncommon but advantageous approach for large interstitial uterine fibroids. Myomectomy is performed via laparotomy and laparoscopy; however, in selected cases, vaginal myomectomy has been proven to be a safe and an effective surgical procedure. We report the case of a 38-year-old para one woman with complaints of chronic lower abdominal pain. Preoperative workup revealed a thirteen-centimeter interstitial uterine myoma in the anterior wall. Successful myomectomy was performed via the vaginal route. We will share the preoperative images, operative technique, and postoperative images.

This is a case report of a 29-year-old lady who presented with excessive vaginal discharge and sessile cervical fibroid arising from the vaginal portion of the cervix. She was not suitable for uterine artery embolization as she has never previously been pregnant before. She was encouraged to get pregnant and to avoid surgical excision which can lead to hysterectomy. Shortly after, she became pregnant. She had many admissions during pregnancy due to bleeding from the fibroid, and in one occasion she had blood transfusions. The fibroid increased in size to become larger than the head of the baby. An emergency caesarean section was performed at 37 weeks when she attended in labour before the date of her elective caesarean section. She was managed conservatively following delivery in the hope that the fibroid becomes smaller making surgery easier. The fibroid degenerated and reduced in size. Vaginal myomectomy was carried out. The patient is now pregnant for the second time and had a cervical suture at 20 weeks gestation. In this educational case report we discuss the different management options of cervical fibroids and review the literature of other similar cases and their outcome.