Laparoscopic Transabdominal Preperitoneal Excision of a Leiomyoma

Abstract

Introduction: Extrauterine leiomyomas in women without prior gynecologic or intestinal surgery are exceptionally rare.1,2 Most reports describe open surgical resection as treatment for these rare tumors.3 In selected cases, however, a minimally invasive approach may be feasible. Materials and Methods: The patient is a 76-year-old woman with hypertension, obesity (body mass index 35 kg/m2), and a previous right knee replacement who was taken to the operating room for laparoscopic sigmoid colectomy for a large endoscopically unresectable polyp diagnosed on screening colonoscopy. Preoperative staging computed tomography revealed an incidental 3.9 × 4.2 × 4.8 cm lobulated, heterogeneous enhancing mass in the right lower quadrant. After completion of the laparoscopic sigmoid colectomy using a standard medial to lateral dissection technique and stapled coloproctostomy, we then performed a transabdominal preperitoneal excision of the pelvic mass. Results: The patient had an uneventful recovery and was discharged on postoperative day 3. At clinic follow-up, she was doing well without complaints. Surgical pathology revealed a 5 cm tubulovillous adenoma with focal high-grade dysplasia in the sigmoid colon in the background of eosinophilic colitis. The pelvic mass was consistent with a leiomyoma. Conclusion: This case highlights a minimally invasive approach for treatment of an extremely rare preperitoneal extrauterine/extraintestinal leiomyoma in a patient without prior gynecologic or intestinal surgery. No competing financial interests exist. Runtime of video: 4 mins 55 secs