Introduction: Performing a laparoscopic myomectomy still poses a challenge for many minimally invasive gynaecologists, particularly when the fibroid size is large. Uliprisal Acetate has been introduced as a new drug for the medical management of uterine fibroids. We looked into this medical alternative as an adjuvant therapy prior to laparoscopic myomectomy for the management of a fertility-preserving surgery.

Objective: To elaborate the surgical experience involved in performing a laparoscopic myomectomy post usage of Ulipristal Acetate for a duration of 3 months.

Case Study: 40 year-old lady/nulliparous presents with an increasing abdominal distension over 2 years. Physical examination revealed a central mass palpable up till the xiphisternum. Ultrasonography and MRI revealed a huge intramural fibroid. She was advised for a Total Abdominal Hysterectomy in view of the size of the fibroid. However she was adamant for conservation of her uterus.  Ulipristal Acetate (Esmya) was administered (for a total of 3 months) with an idea of shrinking the fibroid to a surgically approachable size. We present here the findings during surgery and discuss its outcomes.

Conclusion: Usage of Ulipristal Acetate is an acceptable & a preferable alternative to GnRH agonists; for women with symptomatic fibroid and no drug compliance issue. It is useful when there is a request for uterine preservation. Inevitably the laparoscopic approach provides faster recovery, diminished blood loss and decreased adhesions compared to laparotomy. Although it can be a technically challenging procedure, it is still feasible with increased competence, advanced surgical instruments and simpler suturing materials.