Surgical Approach to a Type 8 Vaginal Myoma in the Endopelvic Fascia

Study Objective

To review the literature for the prevalence of vaginal myomas and to demonstrate a case of isolated vaginal myoma excision.

Design

Case report with surgical videos.

Setting

Tertiary care hospital.

Patients or Participants

One patient.

Interventions

Patient was a 39 y/o G2P2 with vaginal fullness and bleeding that was found to have a 6 cm vaginal myoma that was filling the vaginal vault and was attached only to the anterior vagina based on office exam and vaginoscopy. MRI was performed and demonstrated a vaginal myoma with no other myomas, though location of the attachment on imaging was not clear. Plan was made for vaginal approach to excision, and this was performed with both hysteroscopy and cystoscopy to inspect possible involvement of surrounding structures. Key steps of procedure included use of vasopressin to assist with hemostasis, blunt dissection in the myoma capsule planes to remove myoma without injuring surrounding structures, and suture plication after excision to repair the endopelvic fascia and vaginal mucosa.

Measurements and Main Results

Vaginal myoma was removed successfully with no injury to nearby urethra or bladder. Vaginal wall defect was repaired successfully in the style of an anterior vaginal repair with good restoration of normal anatomy noted postoperatively and at post-op visit. Surgical techniques are reviewed in the surgical video.

Conclusion

Isolated type 8 vaginal myomas are rare and identifying their attachments to surrounding structures prior to excision is crucial, but vaginal approach to excision can be safely performed with care being taken to not injure surrounding structures and with endopelvic fascia repair performed after removal.