A case of laparoscopic myomectomy in a patient with severe scoliosis and spinal muscular atrophy.

Abstract

Objective: Spinal muscular atrophy (SMA) is a genetic disease affecting the part of the nervous system that controls voluntary muscle movement. Scoliosis in SMA most likely develops because of a lack of muscular support for the spinal column or because of muscular imbalance. We report a case of laparoscopic myomectomy in a patient with severe scoliosis and SMA. To our knowledge, no prior report has discussed the technical difficulties of laparoscopic myomectomy in the presence of SMA with severe scoliosis.

Patient: A 31-year-old woman was referred to our department for submucosal fibroma with severe anemia. She underwent laparoscopic myomectomy. Surgery was completed successfully without need for open conversion and without any complications.

Conclusions: In patients with severe scoliosis and SMA, vertebral and thoracic deformities can make intubation difficult and reduced lung capacity can cause intraoperative ventilation failure. Thus, such surgery needs to be planned in conjunction with the anesthesiology department. Laparoscopic myomectomy in a patient with severe scoliosis enables improved operative visibility and easier access to pelvic organs. We believe that in patients with less pelvic working space, a laparoscopic approach can increase the working space and improve orientation. In our opinion, severe scoliosis is not a contraindication to this procedure.