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

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.