Robotic-Assisted Laparoscopic Excision of Bladder Leiomyoma at Time of Hysterectomy

Study Objective

To describe the minimally invasive surgical management of a symptomatic bladder leiomyoma in a patient undergoing robotic-assisted laparoscopic hysterectomy for uterine fibroids.

Design

Descriptive case report with video demonstration of partial cystectomy for excision of bladder leiomyoma.

Setting

Tertiary care academic medical center.

Patients or Participants

A 49-year-old female with menorrhagia, bulk symptoms, difficulty urinating, and hematuria during menses. Pelvic MRI obtained during workup demonstrated multi-fibroid uterus and an incidental 2.5 cm well-circumscribed bladder mass at the dome.

Interventions

After incomplete transurethral resection and pathologic confirmation of bladder leiomyoma, the patient underwent robotic-assisted total laparoscopic hysterectomy with bilateral salpingectomy, cystoscopy, ureteral stent placement, and partial cystectomy. The retropubic space was developed, and the leiomyoma was excised en-bloc through a full-thickness bladder incision. The bladder was closed in two layers.

Measurements and Primary Results

The bladder leiomyoma was successfully excised robotically with preservation of adjacent structures. The full-thickness bladder defect was repaired in two layers with watertight closure confirmed by intraoperative leak testing. The patient was discharged on postoperative day one. Foley catheter was removed on postoperative day five without complication.

Conclusion

Bladder leiomyomas are rare, accounting for less than 0.5% of bladder tumors. Though uncommon, they can be approached minimally invasively using robotic-assisted surgery. This case demonstrates that careful preoperative imaging, appropriate localization, and familiarity with retropubic anatomy allow for safe excision.