Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts (Drs. Clark, Feltmate, and Cohen).
Department of Obstetrics and Gynecology, University of Texas Health-McGovern Medical School, Houston, Texas (Dr. Leon).

ABSTRACT

Introduction: Parasitic leiomyoma is a rare condition that may be spontaneous or iatrogenic in origin. Laparoscopic uterine surgery and tissue morcellation are procedures that may lead to the development of parasitic leiomyoma.

Case Description: We report the case of a 36-year-old woman with a history of a laparoscopic myomectomy and uncontained power morcellation who presented to our institution 6 years later with 2 large parasitic fibroids together weighing over 1 kg. We additionally present a review of the literature on development of parasitic leiomyoma after myomectomy, summarizing 35 published cases in addition to our own.

Conclusion: Parasitic leiomyoma is estimated to occur after 0.20 to 1.25% of laparoscopic myomectomies, and is diverse in it’s presenting symptoms and surgical findings. Tissue morcellation is suspected to be a risk factor in the development of this condition.

Key Words: Parasitic leiomyomas, Myomectomy, Uncontained morcellation.

The post Parasitic Leiomyomas Following Laparoscopic Myomectomy first appeared on JSLS.

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).

ABSTRACT

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.

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The post Parasitic Myomas Due to Laparoscopic Intra-abdominal Morcellation first appeared on JSLS.

OB/GYN Hospitalist, Department of Obstetrics & Gynecology, Northwest Community Hospital, Arlington Heights, IL, USA (Dr. Markuly). Director, Minimally Invasive Gynecologic Surgery, Advocate Lutheran General Hospital, Park Ridge, IL, USA and Director, AAGL/SRS Fellowship in Minimally Invasive Gynecologic Surgery, Advocate Lutheran General Hospital, USA (Dr. Miller). Undergraduate, Northwestern University, Evanston, IL, USA (Szela).

ABSTRACT

Introduction: Uterine rupture is an acute obstetric emergency requiring a rapid response by a multidisciplinary team of physicians and allied health care professionals to minimize the risk of both maternal and neonatal morbidity and death. A risk factor is previous myomectomy. Robotic-assisted laparoscopic myomectomy is a technologically cutting-edge approach to a common surgical procedure, myomectomy. Pregnancy after robotic-assisted laparoscopic myomectomy has been reported in the literature.

Case Description: We report a case of spontaneous uterine rupture in a subsequent pregnancy after robotic-assisted laparoscopic myomectomy.

Discussion: With use of robotic assistance, the technique changes when compared with standard laparoscopic myomectomy. Areas of potential concern are the amount and type of energy required to excise the fibroid from the myometrial bed.

Key Words: Myomectomy, Uterine Rupture, Robotic Surgery, Laparoscopy, Spontaneous, Pregnancy.

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The post Uterine Rupture After Robotic-Assisted Laparoscopic Myomectomy first appeared on JSLS.

Department of Gynecology and Obstetrics, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil (all authors).

ABSTRACT

Hysteroscopic myomectomy is the surgical procedure of choice for the treatment of submucous or intramural myomas that protrude into the uterine cavity in patients with abnormal bleeding and/or infertility. It is a minimally invasive procedure associated with a low complication rate. Complications of hysteroscopy include uterine perforation, intraoperative and postoperative uterine bleeding, water intoxication, gas embolism, and injuries of the bladder, ureters, and major blood vessels, in addition to late complications, such as infections and synechiae. This case report describes iliac artery injury during hysteroscopic myomectomy. A review of the literature shows that this complication has not been recorded.

Key Words: Hysteroscopy, Myomectomy, Complications, Iliac artery injury

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The post Iliac Artery Lesion as a Severe Complication of Hysteroscopic Myomectomy first appeared on JSLS.