Design: Video

Setting: Academic teaching hospital operating room.

Patients or Participants: 30yo G1P0 at 16w5d gestation with a 21cm fundal pedunculated fibroid and increasing bulk symptoms and abdominal pain who underwent a mini-lap myomectomy during pregnancy.

Interventions: Myomectomy through mini-laparotomy.

Measurements and Main Results: Successful removal of a 2655g leiomyoma from a 16wk gravid uterus. Patient subsequently had an uncomplicated remainder of the pregnancy and normal spontaneous vaginal delivery at 39 weeks.

Conclusion: In this video, we review the presurgical considerations and indications for myomectomy during pregnancy. We also demonstrate the surgical technique for mini-laparotomy myomectomy to optimize visualization, reduce blood loss, and minimize obstetric complications. Finally, a vaginal delivery can reasonably be offered to carefully selected patients following mini-lap myomectomy in pregnancy.