9cm Giant Fibroid, Uterus Like 10-Week Pregnancy:
Removed Through a Hidden Scar

The Patient: A Shocking Discovery at Age 20

In her early 20s, Xiao Rui (name changed) never imagined a casual checkup would change everything. She had always thought her protruding belly was simply weight gain. It wasn't.

"I always thought women only got uterine fibroids in middle age. Does a 9cm fibroid mean open surgery? I'm not even married yet — will I have a long, ugly scar?"

Because of her severe obesity, the thick abdominal wall had masked the underlying pelvic mass. She had no heavy menstrual bleeding or other warning signs. A routine gynecological ultrasound revealed the truth:

• Single uterine fibroid measuring approximately 9 cm in diameter
• Uterus enlarged to roughly the size of a 10-week pregnancy
• Location: Anterior uterine wall, intramural, partially subserosal
• Classification: "Giant uterine fibroid" (≥8–9 cm or ≥800 g)

Expert Consultation: Demystifying Fibroids

Accompanied by her family, Xiao Rui consulted Prof. Sun Dawei at AMCARE Beijing. In the clinic, he patiently addressed every fear:

Prof. Sun explained:

• Uterine fibroids have no age limit. Hormonal fluctuations, obesity, and irregular lifestyle can all contribute.
• Regular gynecological ultrasound screening is essential for all adult women, regardless of age or sexual history.
• Xiao Rui's young age and high estrogen levels had fueled rapid fibroid growth, allowing it to reach 9cm before detection.

Why Surgery Was Necessary

At 9cm, Xiao Rui's fibroid had crossed into the "giant fibroid" category. Watchful waiting was no longer appropriate because:

• Symptomatic risk rises sharply with fibroids of this size
• Potential for heavy bleeding, anemia, pelvic pressure, urinary frequency, and constipation
• Fertility could be compromised if the fibroid continued to grow
• Open abdominal surgery would cause large scar, slower recovery, and greater trauma

Primary treatment goal: completely remove the fibroid while preserving the uterus and maximizing fertility potential.

The Surgical Plan: Transumbilical Single-Port Myomectomy (LESS-M)

Given Xiao Rui's age, unmarried status, obesity, and strong desire for a scar-free outcome, Prof. Sun recommended transumbilical single-port laparoscopic myomectomy (LESS-M):

Prof. Sun's extensive experience in single-port laparoscopy — thousands of successful cases — gave Xiao Rui the confidence to proceed.

Three Major Technical Challenges

This was far from a routine operation. The surgical team had to navigate three distinct hurdles:

1. The Anesthesia Challenge

With severe obesity, airway management and intraoperative ventilation become significantly more difficult. Dr. Li, the attending anesthesiologist, performed a focused airway assessment:

• Detailed evaluation of mouth opening and airway anatomy
• Prepared difficult-airway backup equipment: video laryngoscope and video laryngeal mask
• Emergency airway plan ready to ensure ventilation at all times

2. The Bleeding Risk

A 9cm fibroid carries substantial blood supply. To reduce intraoperative bleeding, the team decided on a preoperative medical shrinking protocol:

3. The Surgical Access Challenge

Single-port surgery through a 2cm umbilical incision is inherently demanding:

• All instruments share one channel — easy for tools to interfere with each other
• Limited workspace — every movement must be precise
• Fibroid was hard and dense, with blurred boundaries between the tumor core and outer capsule
• Rich blood supply meant any bleeding could rapidly obscure the operative field

The Procedure: Precision Under the Microscope

During surgery, the team confirmed the complexity:

• The fibroid was deeply rooted in the uterine myometrium
• Numerous feeding vessels surrounded the mass
• The tumor capsule was densely adhered to the fibroid core, with no clear separation plane
• Every step risked bleeding that could obscure vision

Prof. Sun, assisted by Dr. Shi and Dr. Wu of the gynecology team, executed the procedure with meticulous technique:

Result: No active intraoperative bleeding. The uterine muscle wall was carefully preserved. Fertility function was protected.

Throughout the procedure, the anesthesiologist remained at the patient's side, adjusting general anesthesia depth, monitoring vital signs, and maintaining stable circulation and breathing.

Personalized ERAS: Beating the Obesity Risks

Because severe obesity dramatically increases the risk of deep vein thrombosis and pulmonary embolism after surgery, AMCARE's gynecology team designed a personalized ERAS pathway specifically for Xiao Rui:

Gentle Pre-Op Preparation

Breaking from traditional preoperative protocols, ERAS offered a more humane approach:

• No prolonged fasting — clear liquids allowed 2–3 hours before anesthesia
• No mechanical bowel preparation — no uncomfortable enemas
• Reduced hunger, thirst, and insulin resistance
• Better muscle preservation and faster recovery

The nursing team provided comprehensive wound care, pain management, dietary guidance, and psychological support throughout her stay.

Recovery: From Anxiety to Relief

"I'm so glad I chose the right doctor and the right procedure. The anxiety and dark cloud that had been weighing on me have completely disappeared." — Xiao Rui

About Uterine Fibroids

Uterine fibroids are the most common benign tumors of the uterus. They affect nearly 70% of women at some point in life. About 30% of affected women develop symptoms requiring treatment.

What This Means for International Patients

This case demonstrates AMCARE's ability to handle complex, high-risk gynecological cases that many patients cannot access quickly in their home countries:

• Expert surgeons with thousands of single-port laparoscopic procedures
• Multidisciplinary anesthesia and nursing teams experienced with obesity and high-risk patients
• Personalized ERAS protocols that reduce complications and shorten recovery
• Fertility-preserving techniques for young, unmarried, or family-planning patients
• Cosmetic outcomes with scars hidden in natural body folds
• Multilingual international patient coordination from first inquiry to post-operative follow-up