Successful pregnancy following myomectomy of a giant uterine myoma: role of a combined surgical approach

PURPOSE: There are very few reports in the literature about the conservative surgical approach of large uterine myoma. The individualization of the surgery approach, the technical expertise and skill of the surgeon, the use of modern technologies/facilities could offer the optimal individualized treatment. METHODS: We performed a conservative combined surgical approach consisting of open laparoscopy myomectomy followed by laparotomy for the treatment of a very large uterine myoma of the anterior uterine wall in a 27-year-old non-pregnant woman with a history of progressive abdominal distension and symptoms related to abdomen pressure and constipation. RESULTS: The myoma weighted 12.010 kg. The postoperative course was good and 20 months after surgery, the patients had a successful pregnancy with a spontaneous delivery at the 39th week of a healthy baby weighting 3.260 kg. CONCLUSIONS: In the case reported here, the careful pre-surgical evaluation, the technical expertise and skill of the surgeon, the choice of a combined approach with laparoscopy and open surgery and the use of modern surgical instruments have enabled us to achieve a significant result: the preservation of the anatomical integrity of the uterus and adnexa which allowed a successful natural pregnancy with spontaneous delivery.