Central Vertical Spreading: A Structured Technique for Vaginal Extraction of Large Fibroids.

INTRODUCTION: Extraction of large fibroids during total laparoscopic hysterectomy (TLH) remains technically challenging, particularly under limited vaginal visualization. Current transvaginal extraction methods are often experience dependent, and standardized procedural sequences have not been fully established. CASE DESCRIPTION/TECHNIQUE DESCRIPTION: We describe a structured central vertical spreading technique for transvaginal extraction of large fibroids following laparoscopic enucleation during TLH. The specimen is placed in a retrieval bag and exteriorized vaginally. Controlled vertical incisions confined to the visible operative field are performed sequentially, followed by rotational repositioning and connection of incision lines. This stepwise sequence progressively reduces the effective extraction diameter while preserving structural continuity. Five consecutive cases after protocol standardization were evaluated to assess procedural feasibility. DISCUSSION: The technique introduces a structured geometric principle that transforms vaginal specimen extraction from an experience-dependent maneuver into a reproducible procedural technique. In this series, all specimens were removed without powered morcellation, additional port placement, bag rupture, or extraction-related complications. This nonpowered approach may offer a structured alternative to powered morcellation in appropriately selected cases.