Open Morcellation Through Mini-Laparotomy: A Novel Technique for the Removal of Large Pedunculated Uterine Fibroids Without Full-Length Laparotomy

Removal of large uterine fibroids traditionally requires extended midline laparotomy, leading to significant postoperative morbidity and poor cosmetic outcomes. While laparoscopic surgery offers a favourable outcome, it is not possible in case of large fibroids. Morcellation is a technique used in laparoscopic surgeries, which helps in the disintegration of fibroid into small parts before taking it out. This technical report describes a technique for removing large pedunculated fibroids via a small infra-umbilical laparotomy using manual morcellation principles. Patients should be selected after mapping of fibroids using MRI and ultrasound scanning. Uterine tourniquet and vasopressin injection before the detachment of fibroid will help to reduce intra-operative bleeding. The mass is progressively peeled inside the abdominal cavity in concentric layers until small enough for extraction through a 4-6 cm incision. This technique allows for safe removal of large fibroids without requiring extended incisions or specialized morcellation equipment, making it ideal for low-resource settings or patients seeking improved cosmetic outcomes.