Design: One patient consented to a laparoscopic approach to remove her massively enlarged uterus and verbally agreed to have her surgery recorded for educational purposes. The surgery lasted roughly 9 hours and the patient was admitted for observation and discharged in stable condition the following day. She had uncomplicated 2- and 6-week post-operative visits.

Setting: The patient was placed in dorsal lithotomy with both arms tucked for her surgery. Entry was obtained through a vertical mini-laparotomy in the suprapubic region, knowing that the site would be utilized during the surgery for hand-assist uterine manipulation and removal of the uterus by morcellation. She had five additional laparoscopic ports placed to facilitate the surgeon’s ability to alternate and operate on both sides of the patient.

Patients or Participants: The surgery was performed on a single patient with a 36-week sized, 5300 gram uterus causing abnormal uterine bleeding and bulk symptoms. She reported being pain-free, not requiring analgesia and overall feeling well by her 2 week post-operative outpatient visit.

Interventions: The patient underwent a cystoscopy and placement of ureteral stents by Urology followed by a total laparoscopic hysterectomy, bilateral salpingectomy, bag-contained morcellation via a mini-laparotomy, and repeat cystoscopy by our team.

Measurements and Main Results: The main result of this surgical approach was patient satisfaction and overall wellbeing. The patient was pain free by 2 weeks post-operatively without any limitations on her typical activities. She also did not experience any post-operative complications despite a prolonged and complex surgery.

Conclusion: Despite an enlarged uterus filling the abdominal cavity, the strategies used and described in this video demonstrate that a laparoscopic approach is feasible and can have excellent post-operative outcomes