Miss Nazma (name changed) a 39 yr old unmarried Egyptian lady presented at Sunrise Hospital with complaints of heavy menstrual bleeding leading to anaemia and a ct scan report of a large uterus studded with fibroids. This patient is due to get married in November 2014 and hence was very keen that her uterus (womb) be conserved so that she can have children in the future. Previously this patient had undergone open (cutting the whole abdomen open) myomectomy (removal of 4 to 5 fibroids in Egypt in 2000 and 2006). Inview of her history of previous surgeries and with the large uterus (upto 30 weeks size) she was advised a hysterectomy for her health by all the gynaecologists she consulted in Egypt, UAE and India. These gynaecologists also told her that the hysterectomy could never be done by laparoscopy owing to the large size of the uterus and also because of her previous surgeries. But she wanted her uterus she wanted to have her own children.
At Sunrise hospital Delhi team of gynaecological laparoscopists Dr Hafeez Rahman & Dr. Nikita Trehan successfully performed her laparoscopic surgery wherein more than 200 fibroids were laboriously removed from the uterus and the uterus was stitched back into a normal shape for her future pregnancies. Also and additional procedure called LUAL (Laproscopic uterine artery ligation from origin) was performed to prevent the recurrence of fibroids and to cause shrinkage of fibroids which may be left behind. All these 200 fibroids were then removed carefully from the body in an endobag and the larger ones were removed with the help of a morcellator. The patient totally recovered from the procedure and was discharged the next day.
Although fibroids are a very common condition in women of reproductive age this variant of fibroid called as CELLULAR LEIOMYOMA where almost all the cells of the uterus are involved in fibroids is a rare condition and poses a challenge to every gynaecologist .But in safe hands even extremely difficult cases can be managed by laparoscopy today.