Surgical Considerations in Parasitic Fibroid Excision

Abstract

<h3>Study Objective</h3> To provide an overview of the etiology and risk factors of parasitic fibroids and to demonstrate laparoscopic considerations during the excision of abdominal and pelvic parasitic fibroids. <h3>Design</h3> Surgical video. <h3>Setting</h3> Academic hospital. <h3>Patients or Participants</h3> 38-year-old with symptomatic uterine fibroids and four prior myomectomies who presents for second opinion regarding the management of uterine and extra-uterine fibroids. <h3>Interventions</h3> Parasitic fibroids are a rare variant that has no connection with the uterus itself and may develop de novo or iatrogenically from prior fibroid surgery. Limited retrospective data estimates occurrence in 0.2-1.25% of cases after laparoscopic myomectomy and 0.1%-1% of cases specifically using uncontained power morcellation. These fibroids often occur along large vessels including the omental and mesenteric arteries, adding surgical complexity during excision. Proposed methods to prevent dissemination include removal through an in-bag containment system, intact removal, and irrigation. We demonstrate a successful laparoscopic myomectomy with excision of abdominal and pelvic parasitic fibroids located proximal to key anatomic structures, and we exhibit measures to prevent further dissemination. <h3>Measurements and Main Results</h3> N/A. <h3>Conclusion</h3> Consider parasitic fibroids on the differential of pelvic mass after previous myomectomy. Consider the possible proximity of parasitic fibroids to key anatomic structures to avoid vascular, urinary, bowel complications. To date, the best preventative measures include in-bag containment, intact removal and irrigation but continued study is needed.