Background: Surgeons often use morcellation techniques in cases with large fibroid uteri to maintain a minimally invasive approach. It is extremely rare that standard techniques fail to morcellate a fibroid.

Case: A 77 year-old postmenopausal women presented with an enlarged fibroid uterus and pelvic organ prolapse and elected to proceed with a total vaginal hysterectomy, bilateral salpingo-oophorectomy, colpocleisis, perineorrhaphy, retropubic synthetic midurethral sling, and cystoscopy. Intraoperative, a large 16 cm calcified fibroid was encountered and standard surgical techniques to manually morcellate the fibroid were unsuccessful. Orthopedic surgery was consulted intraoperatively. Utilizing orthopedic bone fragmenting instruments, the fibroid was able to be safely morcellated vaginally. There were no perioperative complications and the patient is doing well postoperatively.

Conclusion: Utilizing a multi-disciplinary approach and maximizing on the expertise of different surgical subspecialties avoided the need for laparotomy and maintained the benefits of a minimally invasive surgical approach.