PMC9977630_01
Computed tomography scan of the pelvis highlights a uterine size of 6.4cm x 5.4cm with an endometrial thickness of 12mm.
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FIG1
A computed tomography (CT) of the chest, abdomen, and pelvis confirmed a uterine size of 6.4cm x 5.4cm, a singular subserosal uterine leiomyoma measuring 3.4cm x 4.2cm and an endometrial thickness of 12mm (Figure 1).
Patient secured in the Trendelenburg position at a 20-degree tilt with stationary shoulder blocks and liberal arm and leg padding. The pneumoperitoneum is maintained at 10mmHg.
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FIG2
She was secured in a low lithotomy position with liberal padding on the legs and arms (Figure 2).
(A) Division of the infundibulopelvic ligament. Intraoperative visualization is significantly improved by utilizing a low insufflation pressure and adequate exposure is achieved with a 20-degree Trendelenburg tilt and an additional laparoscopic grasper. (B) Closure of the vaginal vault using a delayed-absorbable barbed suture and "Belfast loop." Excessive abdominal adiposity masks the lengths of the laparoscopic instruments when suturing the vaginal vault.
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FIG3
The excessive intra-abdominal adiposity led to challenges with visceral exposure and retraction; however, this was overcome by utilizing the additional laparoscopic grasper operated by the primary assistant (Figure 3A). The procedure was completed in 90 minutes and the estimated blood loss was approximately 250ml.