Four-Step Technique for Successful Dissection in Laparoscopic Surgery for Parasitic Myomas

Abstract

Study Objective Parasitic myomas (PMs), mainly caused by intra-corporeal power morcellation during previous laparoscopic surgery, is gradually increasing in recent years. However, techniques for the surgical treatment of PMs remain largely unestablished because of the diversity of occurrence sites. We focused on safe and consistent strategies for dissecting PMs in various sites. Design Thirteen patients with PMs were treated with laparoscopy at our institution between 2008 and 2020. We will show our operative procedure for dissecting PMs using our four-step technique in three of these cases. Setting Urban general hospital in Japan. Patients or Participants Patients were placed in the lithotomy position. We use a modified diamond trocar placement. Case 1: A 45-year-old woman with PMs occurring under the pelvic peritoneum three years after total laparoscopic hysterectomy for a fibromatous uterus. Case 2: A 42-year-old woman with PMs occurring under the bladder peritoneum two years after total laparoscopic hysterectomy for a fibromatous uterus. Case 3: A 61-year-old woman with PMs of the mesoappendix eight years after total laparoscopic hysterectomy for a fibromatous uterus. Interventions Our four steps for dissecting PMs-identify the positional relationship between the PMs and organs considering organ deviation identify the boundary line between PMs and organs pull PMs with the proper force of traction for separation from organs and surrounding loose connecting tissue 4. identify and coagulate feeding vessels to avoid major bleeding. Measurements and Main Results In all surgeries performed with this technique, PMs were resected successfully and no intra or postoperative complications occurred. Conclusion By following our simple four steps, we were able to customize removal of each PM depending on its location. The four-step technique is safe and effective for successful dissection of PMs occurring in various sites.