Parasitic Myomas Due to Laparoscopic Intra-abdominal Morcellation
Giulia Giovanardi, MD, Stephane Oden, MD, Haitham Khalil, MD, Loic Marpeau, MD, PhD, Renato Seracchioli, MD, Horace Roman, MD, PhD
Minimally Invasive Gynaecological Surgery Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy (Drs. Giovanardi, Seracchioli). Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France (Drs. Oden, Khalil, Marpeau, Roman).
Introduction: The use of electric tissue morcellators is crucial to allow the extraction of voluminous parts from a small laparoscopic incision, especially when the vagina is not opened. This report discusses how morcellation could be associated with the risk of intra-abdominal parasitic myomas developing.
Cases Description: Three women were affected by intra-abdominal parasitic myomas several years after laparoscopic hysterectomy or myomectomy with specimen extraction by morcellation. The myomas were discovered either by accident (case 3) or because the patients were symptomatic (cases 1 and 2). The symptoms are usually unspecific.
Discussion: The use of a morcellator may be associated with the risk of disseminated myoma fragments during the procedure and the rare development of complications from parasitic myomas. Meticulously inspecting the abdominal cavity at the end of the procedure and assessing the size of the uterus and fibroids before the procedure can reduce this risk. It is very likely that these cases are underestimated because patients may be asymptomatic and these parasitic myomas can occur years after the operation.
Key Words: Myoma, Parasitic myoma, Morcellation, Myomectomy, Laparoscopic hysterectomy.