This video shows the case of a patient who underwent a laparoscopic myomectomy for a 15 cm large base subserous myoma.
The technique for the myomectomy was as usual the incision with monopolar hook of the serosa and myometrium until the cleavage plane is reached, followed by a mechanical enucleation of the myoma.
Once we enucleated the myoma, we had to face a conspicuous bleeding.
A suture of the uterus was then carried out with figure of eight interrupted stiches to try to reach a quick hemostasis, but in vain. The bleeding was going on. We tried to find the source of the hemorrhage: when we moved the myoma we saw that the blood was coming out from the myoma itself and moreover there was a large adhesion between the myoma and the mesenteric vessels of the bowel.
After the dissection of the adhesion, it was possible to see how the vascularization of the myoma was interconnected with the one coming from the mesentery. It was possible to achieve a good hemostasis only after having occluded the bleeding vessels of the bowel mesentery.