Utilization of Transvaginal Morcellation for Large Cervical Fibroid During Laparoscopic Assisted Hysterectomy: A Case Report.

Introduction: Cervical fibroids are a rare subtype of uterine fibroid (0.6%) which may cause pelvic pain and abnormal uterine bleeding. When large, they present technical challenges to traditional laparoscopic hysterectomy due to anatomic distortion and limited uterine mobility. This report aims to illustrate a minimally invasive approach to hysterectomy complicated by a large cervical fibroid with limited mobility and laparoscopic visualization. Case Description: A 51-year-old G6P5015 woman underwent hysterectomy for alleviation of pelvic pain secondary to an 11 cm fibroid. Intraoperatively, the fibroid occupied the entire posterior cul-de-sac near the right ureter and extended into the right broad ligament with posterior displacement of the cervix. A combined laparoscopic and vaginal approach was used to complete the surgery. The fibroid was morcellated through a transvaginal approach allowing for debulking of the cervix and completion in a minimally invasive fashion. The patient had an uncomplicated postoperative course. Conclusions: The potential for laparoscopic assisted vaginal hysterectomy (LAVH) with transvaginal morcellation of fibroids as an alternative to total abdominal hysterectomy (TAH) is a worthwhile consideration to reduce recovery time and postoperative complications that can accompany TAH.