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Case Reports
. 2025 Jul 25:17:2313-2323.
doi: 10.2147/IJWH.S528452. eCollection 2025.

Hymen-Sparing Myomectomy: Innovative Laparoscopic Approach for Prolapsed Pedunculated Cervicovaginal Leiomyoma in a Virgin Case

Wael Saad Elbanna  1 , Asmaa Khedr Elkaw  1 , Mostafa Mahmoud Elabd  1
Affiliations
Case Reports

Hymen-Sparing Myomectomy: Innovative Laparoscopic Approach for Prolapsed Pedunculated Cervicovaginal Leiomyoma in a Virgin Case

Wael Saad Elbanna et al. Int J Womens Health. .

Abstract

Leiomyoma is the most common benign tumor of the female genital tract. It may develop subserous, intramural, or submucous. The submucous subtype accounts for 5% of all cases, and it may become pedunculated or prolapse outside the uterine cavity, resulting in vaginal bleeding and pelvic pain, significantly impacting the quality of life, especially for larger leiomyomas. The management of such cases may require vaginal access, which may disrupt hymen integrity and is not accepted in conservative communities. Here, we present an innovative hymen-conserving Laparoscopic-And-Suprapubic Hysteroscopic Approach (LASHA) via anterior colpotomy and myomectomy for endometrial cavity exploration and management of a prolapsed pedunculated cervicovaginal leiomyoma in a virgin patient. A 30-year-old virgin presented to the clinic with heavy menstrual bleeding for the past 6 months. Abdominal ultrasound showed an enlarged uterus with multiple uterine myomas; the largest one was in the cervicovaginal zone, filling the vagina, showing a solid hypo-echoic mass, well delineated, filling the vaginal margins, and suggesting a prolapsed, pedunculated cervicovaginal leiomyoma (5.7x6.6x 8.3 cm). Other subserosal and intramural myomas ranged from 2 to 7 cm. The LASHA approach was decided to preserve the hymen's integrity based on the patient's desire, resulting in a successful tumor excision. In summary, the LASHA approach of a prolapsed, pedunculated cervicovaginal leiomyoma is an adequate, safe, and socially accepted alternative in conservative societies. Therefore, the indications of laparoscopy could be extended to endometrial cavity exploration and managing cervicovaginal leiomyoma in virgin women rejecting vaginal approaches. However, this technique necessitates adequate equipment and skills in laparoscopic surgery.

Keywords: hymen; hysteroscopy; laparoscopy; leiomyoma; myomectomy.

Plain language summary

Uterine fibroids (also called leiomyomas) are a common benign cancer among women. It can develop in different parts of the uterus. Nevertheless, uterine fibroids, which develop inside the uterine cavity, might grow, forming a stalk and go down outside the uterus, leading to excessive bleeding and lower abdominal pain. In such cases, the doctors surgically remove the fibroids through the vagina. However, this approach might affect hymen integrity, which is not accepted in conservative communities. Therefore, we describe a novel hymen-conserving Laparoscopic-And-Suprapubic Hysteroscopic Approach (LASHA) for exploring and treating large pedunculated fibroids that have extended to the vagina in a virgin patient. The patient was 30 years old and presented to our clinic complaining of heavy menstrual bleeding for the past six months. By ultrasound examination, we found a distended uterus containing multiple fibroids, with the largest one being a pedunculated fibroid that had extended into the vagina. We were able to successfully remove these fibroids using the LASHA approach, emphasizing that this technique is feasible in conservative communities for virgin patients who refuse to perform surgeries through the vagina to avoid the disruption of their hymen. After the operation, the patient recovered well with minimal bleeding and pain and was discharged 24 hours later. At follow-up, she clarified that her symptoms had improved, and she was satisfied with the outcome of the operation.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
(a) Subserous pedunculated myoma measuring (7.3x6.8x6 cm) located at the uterine fundus (FIGO 7). (b) The prolapsed cervicovaginal leiomyoma measuring (5.7x6.6x8.3 cm) arising from the right side of the cervix and protruding from the cervical canal to vagina (FIGO 0). (c)The coronal view demonstrating the distortion of the uterine contour. (d) Showing the multiple fibroids varying in locations (intramural and subserous) and also in their sizes, two small intramural leiomyomas (FIGO 3 and FIGO 4), along with two small fundal subserosal leiomyomas (FIGO 5).
Figure 2
Figure 2
The first pedunculated fundal fibroid identified by the laparoscopy.
Figure 3
Figure 3
Fibroid intra-myometrial injection by vasopressin.
Figure 4
Figure 4
Enucleation and dissection of an intramural fibroid.
Figure 5
Figure 5
Transverse anterior colpotomy incision.
Figure 6
Figure 6
(a) Identification of the prolapsed cervicovaginal leiomyoma through the colpotomy incision. (b) Grasping of the prolapsed myoma out through the colpotomy incision and its excision at its pedicle using the bipolar electrocautery.
Figure 7
Figure 7
(a) Rigid hysteroscopic sheath insertion through the colpotomy incision. (b) Visualization of the endometrial cavity to rule out any other lesions or any source of bleeding.
See this image and copyright information in PMC

References

    1. Giuliani E, As-Sanie S, Marsh EE. Epidemiology and management of uterine fibroids. Int J Gynaecol Obstet. 2020;149(1):3–9. - PubMed
    1. Aydın S, Çelik HG, Maraşlı M, Bakar RZ. Clinical predictors of successful vaginal myomectomy for prolapsed pedunculated uterine leiomyoma. J Turkish Ger Gynecol Assoc. 2018;19(3):146. doi: 10.4274/jtgga.2017.0135 - DOI - PMC - PubMed
    1. Serradilla LN, Gómez-Ríos MA, Nicolás C, Ramón Y, Cajal L. Embolization before surgery of a large pedunculated submucosal myoma prolapsed into the vagina. Acta Obstet Gynecol Scand. 2011;90(5):554–555. doi: 10.1111/j.1600-0412.2011.01108.x - DOI - PubMed
    1. Chandrasiri DACT, Munasinghe BM, Pushpakanthan EJ, Jayasinghe JBU, Nissankaarachchi RD. Vaginal prolapse of a large uterine cervical leiomyoma complicated with cervical inversion: a case report of an extremely rare entity with review of the literature. SAGE Open Med Case Rep. 2022;10:2050313X221135596. doi: 10.1177/2050313X221135596 - DOI - PMC - PubMed
    1. Al-Shukri M, Al-Ghafri W, Al-Dhuhli H, Gowri V. Vaginal myomectomy for prolapsed submucous fibroid: it is not only about size. Oman Med J. 2019;34(6):556–559. doi: 10.5001/omj.2019.100 - DOI - PMC - PubMed

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