Laparoscopic myomectomy consists of three major steps, enucleation, reapproximation, and retrieval of the specimen. There are some difficulties in each of these three steps when performed laparoscopically.

Today I present colpotomy technique for extraction.

We don’t use an electric morcellator and the vagina is used as the retrieval route. The posterior fornix is opened laproscopically using a specially developed vaginal pipe(Vagi-pipe). As the huge tumor did not descend into the deep pelvis due to obstruction, the specimen is divided into some pieces using a usual scalpel introduced via a trocar site. Cutting image is important. There are 2 patterns of how to cut the huge fiborids. Scalpel can only cut straightly, so we have to move the fibroid and cut it effectively.

Then anchor suture is placed in each of the pieces and then fed into the vagina in preparation for extraction. Each specimen is further cored and then finally retrieved through the vagina by pulling each of the sutures.

Precise maneuvering of instrument and improvement of suturing skills will shorten the surgical time.