Laparoscopic management of bladder fibroids: Surgical tips and tricks

Brought to you by the Society of Gynecologic Surgeons. In this video, the authors review steps for the safe laparoscopic excision of bladder fibroids, starting with a review of basic bladder anatomy. Preoperatively, leuprolide is administered for at least 3 months prior to the fibroid excision to reduce the size of the fibroid and diagnostic cystoscopy is recommended to confirm the bladder fibroid location in relation to the trigone. Intraoperatively, cystoscopy is repeated with placement of ureteral stents and the bladder is backfilled to delineate the fibroid borders. The fibroid is excised layer by layer, and the cystostomy is reassessed laparoscopically, with relaxing incisions used as necessary. Angle stitches facilitate intracorporeal knot tying for a 2-layer watertight cystostomy closure. Cystoscopy is repeated at completion of the surgery to reassess the repair site and ureters.