A 9 cm Fibroid After C-Section: Laparoscopic Removal With Three-Layer Suturing for Future Pregnancy

Zoe had recently delivered her first baby by cesarean section. During postpartum follow-up ultrasound, she discovered a 9 cm uterine fibroid.

During breastfeeding, estrogen levels are usually low, somewhat similar to menopause, so many fibroids may shrink after delivery. But Zoe's fibroid did not shrink. It remained large and persistent.

She visited Dr. Zhou from Gynecology. Dr. Zhou explained that surgery was recommended for two main reasons: the fibroid had not shrunk during postpartum breastfeeding, and Zoe still hoped to have another child in the future.

If a large fibroid remained during a future pregnancy, it could increase risks such as red degeneration, torsion, abnormal fetal position, and pregnancy complications.

Zoe had undergone C-section only a few months earlier. If she had another open abdominal surgery so soon, the physical burden could be significant.

After reviewing the ultrasound, Dr. Zhou decided to attempt laparoscopic surgery. The fibroid was located on the anterior wall of the uterus and protruded outward, making laparoscopic access more feasible.

However, the difficulty was still high. A 9 cm fibroid buried deep in the uterine muscle requires careful removal and strong suturing, especially for someone planning another pregnancy.

"Because the patient wants another pregnancy, the uterine closure must be strong and layered. It cannot be a casual closure."
— Dr. Zhou

During the operation, Dr. Zhou first injected vasopressin under the fibroid capsule to help the uterus contract, reduce bleeding, and make the fibroid easier to separate.

The fibroid had a natural capsule, creating a boundary between the tumor and the uterine muscle. After finding the correct layer, Dr. Zhou opened the capsule and carefully peeled the fibroid away, like removing a coat.

Fortunately, the uterine cavity was not entered during removal, which helped reduce the recovery burden for future pregnancy planning.

Closing the large fibroid cavity and suturing the uterine muscle was the most important part of the operation and took about three quarters of the total surgical time.

After the uterus was sutured, the 9 cm fibroid was morcellated into strips and removed through a small incision on the lower left abdomen inside a specimen bag for pathology. Intraoperative blood loss was about 200 ml.

Before the end of surgery, Dr. Zhou injected local anesthetic into the four small abdominal incisions. The anesthesiology team also provided a portable patient-controlled analgesia pump for 24 hours.

Zoe said that when she felt pain, she could press the pump to add medication, helping her through the most painful early stage. She slept well after surgery and recovered quickly in both energy and strength.

"The surgery was not as frightening as I imagined. Laparoscopy, three-layer suturing, and the pain pump made it much easier than my C-section."
— Zoe

Zoe will now wait for the uterus to heal fully, usually around 1.5 to 2 years based on her doctor's advice, before planning for another pregnancy.