Strategy of cervical myomectomy under laparoscopy Wen-Chun Chang, M.D., Szu-yu Chen, M.D., Su-Cheng Huang, M.D., Daw-Yuan Chang, M.D., Ph.D., Li-Yun Chou, M.D., Bor-Ching Sheu, M.D., Ph.D.  Fertility and Sterility  Volume 94, Issue 7, Pages 2710-2715 (December 2010) DOI: 10.1016/j.fertnstert.2010.02.049 Copyright © 2010 American Society for Reproductive Medicine Terms and Conditions

Figure 1 Laparoscopic myomectomy in an anterior cervical myoma, posterior cervical myoma, and central cervical myoma. (A) Preoperative ultrasonographic image of the anterior cervical myoma. (arrow = uterine body; M = myoma.) (B) The myoma is under the bladder. The dotted line indicates the incision. (C) The myoma is exposed with the aid of a myoma screw. (D) Morcellation is performed. (E) The cervical endothelium, the muscle layer, and serosa are sutured with interrupted sutures. (F) Preoperative ultrasonographic picture of the posterior cervical myoma. (arrow = uterine body; M = myoma.) (G) The posterior cervical myoma is above the rectum. The dotted line indicates the incision. (H) Preoperative ultrasonographic picture of the central cervical myoma. (arrow = uterine body; M = myoma.) (I) The central cervical myoma is under the uterine body and resembles a snowman. The dotted line indicates the incision. Fertility and Sterility 2010 94, 2710-2715DOI: (10.1016/j.fertnstert.2010.02.049) Copyright © 2010 American Society for Reproductive Medicine Terms and Conditions

Figure 2 Laparoscopic myomectomy in a lateral cervical myoma. (A) Preoperative ultrasonographic image. (arrow = uterine body; M = myoma.) (B) The myoma arises from the lateral cervix and is growing into the broad ligament. The dotted line indicates the incision. (C) A transverse incision is made at the prominent part of myoma. (D) The myoma is exposed with the aid of a myoma screw, and morcellation is performed. (E) Bipolar coagulation of the pedicular vessels is performed. (F) The wound is sutured with two-layer interrupted sutures. Fertility and Sterility 2010 94, 2710-2715DOI: (10.1016/j.fertnstert.2010.02.049) Copyright © 2010 American Society for Reproductive Medicine Terms and Conditions

Figure 3 Laparoscopic myomectomy in a deep-rooted cervical myoma. (A) Preoperative ultrasonographic image shows the myoma projecting into the vagina. (arrow = uterine body; M = myoma.) (B) The main part of myoma is deep-rooted in the vagina. The dotted line indicates the incision and the arrowheads indicate the bilateral ureters. (C) A transverse incision is made just below the uterine body. (D,G) Attempts to expose the myoma with the aid of a myoma screw have failed. (E, F) The cervical myoma is pushed upward manually in the direction of abdominal cavity. (H) Morcellation is performed. (I) The wound is sutured with two-layer interrupted sutures. Fertility and Sterility 2010 94, 2710-2715DOI: (10.1016/j.fertnstert.2010.02.049) Copyright © 2010 American Society for Reproductive Medicine Terms and Conditions