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Photograph of a uterus following the removal of two large partially transmural myomas. The fibroids can be seen behind the uterus in the cul de sac. Complete hemostasis was assured with bipolar cautery that was applied prior to, during and after the myomectomy (removal of the fibroids). In cases where the defect in the wall of the uterus is more substantial, the uterus may need to be sutured to assure complete hemostasis. The fibroids should be removed from the pelvis, either through a larger (minilaparotomy) incision in the abdominal wall, after morcellation (division into small pieces) through the laparoscopy incisions, or through the vagina following colpotomy (incision through the vaginal wall into the cul de sac of the pelvis). I generally remove the myomas through the existing laparoscopy incisions after morcellation.
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