IMR Press / CEOG / Volume 49 / Issue 8 / DOI: 10.31083/j.ceog4908172
Open Access Case Report
Laparoscopic ultrasonography-guided myomectomy of submucosal myoma for preserving endometrial integrity
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1 Department of Perinatal and Maternal Medicine (Ibaraki), Graduate School, Tokyo Medical and Dental University, 113-8510 Tokyo, Japan
2 Umegaoka Women's Clinic, Umegaoka, Setagaya, 154-0022 Tokyo, Japan
3 Department of Comprehensive Reproductive Medicine, Graduate School, Tokyo Medical and Dental University, 113-8510 Tokyo, Japan
*Correspondence: (Kazuki Saito)
Academic Editor: Michael H. Dahan
Clin. Exp. Obstet. Gynecol. 2022, 49(8), 172;
Submitted: 28 February 2021 | Revised: 11 May 2021 | Accepted: 17 May 2021 | Published: 22 July 2022
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Background: Submucosal myoma is a common gynecological disease that causes menorrhagia and infertility. While hysteroscopic surgery is a minimally invasive and effective method for treating submucosal myomas, its feasibility depends on the size and location of the myomas. Conversely, abdominal procedures enable enucleation of submucosal myomas and preservation of endometrial integrity, but are accompanied by technical difficulties. Herein we report the case of an infertile woman with a submucosal and an intramural myoma who underwent laparoscopic myomectomy using laparoscopic ultrasonography. Case: The patient was a 36-year-old infertile woman. Transvaginal ultrasonography revealed a 15 mm submucosal myoma with a 60% myometrial extension in the anterior uterine wall and a 49 mm intramural myoma in the posterior wall. During myomectomy, the submucosal myoma was not apparent from the external side of the uterus; therefore, laparoscopic ultrasonography was used to detect it. Under ultrasonography, vasopressin was injected between the myoma and the myometrium, thereby separating the layers. Consequently, we were able to resect both myomas without breaching the endometrium. Conclusions: The present case demonstrates the effectiveness of laparoscopic ultrasonography for detecting submucosal myomas and ensuring injection of vasopressin into the proper layer. These advantages allow surgeons to preserve endometrial integrity during laparoscopic myomectomy.

laparoscopic myomectomy
laparoscopic ultrasonography
submucosal myoma
Fig. 1.
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