Laparoscopic Hysterectomy of a Uterus with a Huge Calcified Myoma Through the Lee–Huang Point and Using Scalp and Bone Cutter

Abstract

Background:

A large percentage of cases of hysterectomy involves symptomatic myomas. It can be challenging to retrieve a large uterus after laparoscopic hysterectomy through the natural orifice of the vagina. Moreover, if there is a hard, calcified huge myoma, the task is even more difficult.

Case:

A 53-year-old gravida 4, para 3, female had a huge uterine myoma. Computed tomography scans showed a multilobulated heterogeneous uterine mass ∼13.8 × 9.8 × 11 cm with coarse calcifications at its mid and anterior aspects.

Results:

This patient underwent total laparoscopic hysterectomy with bilateral uterine-artery ligation, and a specimen was removed through her vagina. Manual morcellation was achieved, using 9 No.11 scalpels and a bone cutter. There were no intraoperative complications. This patient had an uneventful postoperative recovery. Her histopathology results were compatible with a leiomyoma.

Conclusions:

Vaginal morcellation of a uterus with a huge calcified myoma is feasible, using multiple scalpels and a bone cutter. This is the only case in cited in the literature in which a bone cutter was used to morcellate a uterus.