Multiple Myomas Research Articles

Intraoperative endoscopic ultrasound guidance for laparoscopic excision of invisible symptomatic deep intramural myomas

The aim of this study was to evaluate the feasibility of intraoperative endoscopic ultrasound guidance for excision of symptomatic deep intramural myomas that are not otherwise visible at laparoscopy. Seventeen patients with symptomatic deep intramural myomas who underwent laparoscopic myomectomy with intraoperative endoscopic ultrasound guidance were followed up and reported. All myomas were removed successfully. The endometrium was breached in one patient. All patients were relieved of their symptoms and three patients presenting with infertility conceived. There were no short- or long-term complications associated with the procedure. One patient who had multiple myomas necessitated intravenous iron treatment prior to discharge. Laparoscopic removal of small symptomatic deep intramural myomas is facilitated by the use of intraoperative endoscopic ultrasound that enables exact localisation and correct placement of the serosal incision.Impact statementWhat is already known on this subject: When the myoma is symptomatic, compressing the endometrium, does not show serosal protrusion and is not amenable to hysteroscopic resection, laparoscopic surgery may become challenging.What do the results of this study add: The use of intraoperative endoscopic ultrasound under these circumstances may facilitate the procedure by accurate identification of the myoma and correct placement of the serosal incision.What are the implications of these findings for clinical practice and/or further research: Intraoperative ultrasound should be more oftenly used to accurately locate deep intramural myomas to the end of making laparoscopy feasible and possibly decreasing recurrence by facilitating removal of otherwise unidentifiable disease.

Safety of treatment of uterine fibroids with the selective progesterone receptor modulator, ulipristal acetate

Introduction: During the last decade, there has been increased emphasis on the role of progesterone in the promotion of fibroid growth, as well as heightened interest in modulating progesterone pathways by use of selective progesterone receptor modulators. Among them, ulipristal acetate (UPA) has proved its efficacy in the management of symptomatic myomas by controlling bleeding and inducing amenorrhea, and reducing the size of myomas in the majority of cases.Areas covered: In this review, we summarize published scientific studies exploring evidence of the safety of selective progesterone receptor modulators and particularly UPA, a drug approved for the management of symptomatic uterine fibroids. We focus essentially on endometrial changes induced by UPA, and also evaluate other safety outcomes.Expert opinion: Data from published reports of randomized controlled trials over 5 years have demonstrated that UPA does indeed induce endometrial changes (known as progesterone receptor modulator-associated endometrial changes), but they have been shown to be both benign and reversible.Novel algorithms published very recently provide an extensive overview that may be considered as the latest expert opinion. Thus, in infertile women of reproductive age, two courses of 3 months of UPA are recommended in case of type 2 myomas or multiple myomas distorting the uterine cavity. Subsequent therapy is determined depending on the response and restoration of the uterine cavity. If there is no desire for pregnancy, long-term (four courses) intermittent therapy may be initiated. In case of a good response, treatment is stopped and restarted only if symptoms recur. In premenopausal women wishing to preserve their uterus, four courses of 3 months is the proposed strategy.Contraindications to prescribing UPA include pregnancy, breastfeeding, genital bleeding of unknown etiology of origin other than uterine fibroids, and presence of uterine, cervical, ovarian, or breast cancer.

Use of augmented reality in laparoscopic gynecology to visualize myomas

To report the use of augmented reality (AR) in gynecology. AR is a surgical guidance technology that enables important hidden surface structures to be visualized in endoscopic images. AR has been used for other organs, but never in gynecology and never with a very mobile organ like the uterus. We have developed a new AR approach specifically for uterine surgery and demonstrated its use for myomectomy. Tertiary university hospital. Three patients with one, two, and multiple myomas, respectively. AR was used during laparoscopy to localize the myomas. Three-dimensional (3D) models of the patient's uterus and myomas were constructed before surgery from T2-weighted magnetic resonance imaging. The intraoperative 3D shape of the uterus was determined. These models were automatically aligned and "fused" with the laparoscopic video in real time. The live fused video made the uterus appear semitransparent, and the surgeon can see the location of the myoma in real time while moving the laparoscope and the uterus. With this information, the surgeon can easily and quickly decide on how best to access the myoma. We developed an AR system for gynecologic surgery and have used it to improve laparoscopic myomectomy. Technically, the software we developed is very different to approaches tried for other organs, and it can handle significant challenges, including image blur, fast motion, and partial views of the organ.

Diagnostic Hysteroscopy and Adenomyosis: The Case of a Uterine Cornual Cavern. A Video Article

Introduction The aim of this study is to show a rare case of adenomyosis presented as a “cavern” which completely involves a uterine cornu. Case description A 39-year-old nulliparous patient, with five previous laparoscopic myomectomies during which multiple myomas and adenomyomas have been removed, presented at the Arbor Vitae Centre for Endoscopic Gynaecology in Rome because of an abnormal uterine bleeding. A 6 cm myoma with multiple endometrial glands inside, located on the left uterine cornu, was enucleated during the last procedure. The ultrasound scan showed a 1 cm endometrial polyp and suspected adenomyosis reaching the serosa on the left uterine cornu. Free-anaesthesia diagnostic hysteroscopy was performed with carbon dioxide as distension medium and using a 30-degree fore-oblique rigid telescope with a diameter of 2.9 mm, covered with a single-flow examination sheath. An electronic hysteroflator was set at a flow rate of 30 mL/min and a maximum intrauterine pressure of 75 mm Hg. Multiple adenomyosis caverns that deepen into the myometrium were found on the left uterine cornu. Conclusions Previous multiple myomectomy may seriously alter the internal uterine anatomy, especially in presence of adenomyosis. In case of presence of numerous recesses in the uterine cavity, a suspicion of adenomyosis should be considered.

多発子宮筋腫のため診断に苦慮した卵管間質部妊娠の一例

多発子宮筋腫のため診断に苦慮した卵管間質部妊娠の一例

Myomectomy during Caesarean Section: Safety and Feasibility of the Procedure

Objective (s): Aim of the study was to evaluate the safety and feasibility of myomectomy during cesarean section.Materials and methods: This prospective observational study was carried out in a private setting at Dhaka city from January 2006 to June 2015. Forty five (45) women with fibroid uterus with pregnancy who needed caesarean section were the target population for this study. Myomectomy was done during caesarean section. Main outcome measures were: difficulty of myomectomy and caesarean section, time needed for operation, per-operative complications, need for blood transfusion, postoperative complications and duration of hospital stay.Results: During the study period total 45 women were found who had pregnancy with myoma and needed caesarean section for various indications. Twenty nine (64.4%) women were of age 26-35 years, 30 (66.7%) were para 0 and in 37 (82%) cases were term pregnancy. In forty one (91.1%) cases myomas were diagnosed preoperatively. Twenty five (55.6%) women had multiple myomas. Commonest site of myoma was body of the uterus (82.2%) and commonest type was intramural (75.6%). Thirty (66.7%) women had myoma of less than 5cm in size. In forty two (93.3%) cases myomectomy was done after delivery of the baby. Myomectomy was successful in all 45 (100%) cases. In thirty (80%) cases caesarean myomectomy was completed within 1 hour. Thirty seven (82.2%) women did not need blood transfusion and thirty eight (84.4%) women had no postoperative complication. Other had minor complications. Forty one (90.1%) women were discharged from hospital within 72 hours of operations.Conclusion: Myomectomy during cesarean section is a safe procedure and it is feasible in almost all cases. Though large scale RCT is needed before giving final conclusion it is not far away when myomectomy during cesarean section will be norm discarding the traditional view of not touching the myoma in pregnancyBangladesh J Obstet Gynaecol, 2015; Vol. 30(1) : 10-14

Preoperative 3-dimensional Magnetic Resonance Imaging of Uterine Myoma and Endometrium Before Myomectomy

Uterine myomas are the most common gynecologic benign tumor affecting women of childbearing age, and myomectomy is the main surgical option to preserve the uterus and fertility. During myomectomy for women with multiple myomas, it is advisable to identify and remove as many as possible to decrease the risk of future myomectomies. With deficient preoperative imaging, gynecologists are challenged to identify the location and size of myomas and the endometrium, which, in turn, can lead to uterine rupture during future pregnancies. Current conventional 2-dimensional imaging has limitations in identifying precise locations of multiple myomas and the endometrium. In our experience, we preferred to use 3-dimensional imaging to delineate the myomas, endometrium, or blood vessels, which we were able to successfully reconstruct by using the following imaging method. To achieve 3-dimensional imaging, we matched T2 turbo spin echo images to detect uterine myomas and endometria with T1 high-resolution isotropic volume excitation–post images used to detect blood vessels by using an algorithm based on the 3-dimensional region growing method. Then, we produced images of the uterine myomas, endometria, and blood vessels using a 3-dimensional surface rendering method and successfully reconstructed selective 3-dimensional imaging for uterine myomas, endometria, and adjacent blood vessels. A Web-based survey was sent to 66 gynecologists concerning imaging techniques used before myomectomy. Twenty-eight of 36 responding gynecologists answered that the 3-dimensional image produced in the current study is preferred to conventional 2-dimensional magnetic resonance imaging in identifying precise locations of uterine myomas and endometria. The proposed 3-dimensional magnetic resonance imaging method successfully reconstructed uterine myomas, endometria, and adjacent vessels. We propose that this will be a helpful adjunct to uterine myomectomy as a preoperative imaging technique in future studies.

Robot-Assisted Laparoscopic Myomectomy, an Alternative to Laparotomy for Numerous Myomas (Over 10)

To evaluate the feasibility of robot-assisted laparoscopic myomectomy in multiple myomas over 10 in number and to compare outcomes with open myomectomy.

Can we consider cesarean myomectomy as a safe procedure without long-term outcome?

Aim: To investigate short- and long-term outcomes in women undergoing cesarean myomectomy (CM).Methods: This was a retrospective study that explored short-term outcomes of women, who underwent cesarean operations with or without myomectomies (CM controls) in a single tertiary center throughout a 6-year-period. For long-term outcomes, the mean duration of follow-up was 6.3 ± 1.0 years.Results: There were no differences among the CM (n= 91) and control groups (n = 60) considering mean change in hemoglobin and hematocrit levels, hemorrhage, as well as requirement for blood transfusions with a slightly increased operative time. Multiple myomas, and cervical and cornual localization were associated with an increased drop of hemoglobin and hematocrit (p < 0.05). Subsequent pregnancy and recurrence rates were 35% (32/91) and 5.5% (5/91), respectively. Preterm delivery (n = 1, 3.1%), uterine dehiscence (n = 1, 3.1%), placenta previa (n = 1, 3.1%) and mild-to-severe post-CM adhesions (n = 8, 25%) were observed in subsequent pregnancies. Recurrence was identified in five of the nonpregnant (5.5%) women, and three of these (4.1%) underwent an additional major surgery. There was no recurrence in subsequent pregnancies.Conclusion: The recurrence of myoma was relatively low following CM. Subsequent pregnancy is protective for recurrence of myoma without increased adhesion formation and obstetric complications.

Tips for Safe Laparoscopic Multiple Myomectomy

Study ObjectiveTo demonstrate key steps in performing safe laparoscopic multiple myomectomy. DesignVideo focuses on stepwise description of all major steps of the surgical technique. PatientTwenty-seven-year-old woman. Informed consent was taken from the subject, and the institutional review board approved this research. InterventionLaparoscopic multiple myomectomy with morcellation in bag. Measurements and Main ResultsAbout one-third of women with fibroids present with symptoms severe enough to warrant treatment. We demonstrate a case of a 27-year-old woman with complaints of secondary infertility and menorrhagia. On examination the uterus was enlarged up to 24 weeks size. Ultrasonography mapping located 7 myomas ranging in size from of 3 to 10 cm and classified as International Federation of Gynecology and Obstetrics classes 2, 3, 4, 5, 6, and 7. Generally, laparotomy or laparoscopy and mini-laparotomy is performed for such cases of multiple myomas. However, the total laparoscopic approach can confer benefits if performed following safe steps and within good time. The following were the key steps of surgery: (1) Higher port position using Lee Huang point for primary port, (2) intermittent vasopressin use for each myomectomy, (3) cold technique of myomectomy, (4) myoma lace creation, (5) multiple layer suturing using double-ended barbed sutures, (6) myoma garland creation, and (7) morcellation in a stomach-shaped bag. ConclusionThe intermittent use of vasopressin is effective in reducing blood loss. Suturing using barbed sutures is less time consuming. Creating lace of myomas by passing a thread through each myoma, prevents losing them in the abdominal cavity and creating garland of myomas by tying two free ends of the lace helps in easier bagging. Morcellation in bag prevents dissemination of bits of myoma and visceral injury. These steps help in performing laparoscopic multiple myomectomy safely. However, this technique should be reserved for selected cases and should be performed by surgical teams with the required expertise and experience.

Efficacy of Tranexamic Acid on Myomectomy-Associated Blood Loss in Patients With Multiple Myomas: A Randomized Controlled Clinical Trial.

To evaluate the efficacy of tranexamic acid (TA) in decreasing blood loss during and after open myomectomy for patients with 3 or more uterine fibroids. This prospective randomized trial was conducted among 132 women subjected to abdominal myomectomy. Patients were equally divided into 2 groups by simple randomization. The study group received perioperative intravenous TA while the control group did not. Intraoperative blood loss was calculated by measuring the volume in the suction apparatus and weighing the surgical swabs in addition to postoperative blood loss collected via a suction drain. Hemoglobin and hematocrit values were determined preoperatively and on the third postoperative day for all cases. Any adverse effects were recorded in both groups. No significant difference was found between the two groups regarding age, body mass index, number, and size of myomas removed. The TA group showed lower amount of blood loss (407 mL) when compared to control group (677 mL; P < .01). Risk estimation has revealed that treatment with TA resulted in decrease in risk of perioperative blood loss by 40%. In the study group, 13 (19.7%) patients required blood transfusion in contrast to 23 (34.8%) patients in the control group (P < .01). Hemoglobin and hematocrit levels were significantly lower in the control group on the third postoperative day (P value = .001) . The TA reduces blood loss during and after myomectomy for patients with multiple uterine fibroids.

Laparoscopic ultrasound procedure can reduce residual myomas in laparoscopic myomectomy for multiple myomas.

To clarify whether the use of laparoscopic ultrasound (LUS) during laparoscopic myomectomy could reduce the number of residual myomas after surgery. A cohort study was conducted. Subjects were women who underwent laparoscopic myomectomy for multiple uterine myomas for the first time. The subjects were assigned to one of two groups: LUS group or non-LUS group. All subjects underwent pelvic MRI 3months before and 6months after surgery, and the number of myomas on MRI was counted by radiodiagnosticians. The extraction rate and residual rate of uterine myomas were compared between the two groups. Fourteen cases with and 30 cases without LUS were analyzed. Median operation times were 171min (range 75-295) and 141min (range 50-260) in cases with and without LUS, respectively (p=0.077). Median extraction rates relative to the total number of myomas were 106% (range 75-147%) in subjects with LUS and 100% (range 71-233%) in subjects without LUS (p=0.480). Numbers of residual myomas were 1 (range 0-3) in subjects with LUS and 2 (range 0-9) in subjects without LUS (p=0.028). Median residual rates of myomas were 6.1% (range 0-20%) in subjects with LUS and 20.0% (range 0-69%) in subjects without LUS (p=0.048). Myomas greater than 3cm in diameter were not observed in either group. The number and residual rate of myomas were significantly less in subjects with LUS as compared with those without LUS.

Omental actinomycosis misdiagnosed as ovarian cancer peritonei

With reference to the report by Kim et al [1], we also experienced a rare case of omental actinomycosis. Kim et al [1] reported pelvic actinomycosis with abundant ascites comparable to cancer. Our case provides an educational tip for the gynecologist who has to manage pelvic actinomycosis misdiagnosed as ovarian cancer. A 49-year-old woman was transferred from a local clinic with a working diagnosis of right ovarian cancer and multiple myomas. The patient was para 5-2-2-3 and the family history was noncontributory. She was postmenopausal. She had not taken a gynecological examination for almost 5 years. The pelvic examination revealed a huge uterus, an intrauterine device (IUD) that had been inserted for 10 years, and motion tenderness of the cervix. The physical examination revealed mild diffuse abdominal tenderness. We removed the IUD during the pelvic examination. The following laboratory results were reported: white blood count 15.1 103/mL; hemoglobin/hematocrit 11.9 g/dL/33.9%; platelets 637 103/mL; prothrombin time international normalized ratio 1.10; activated partial thromboplastin time 28.2 seconds; carcinoembryonic antigen 2.2 ng/mL; and CA125 84.8 U/mL. Computed tomography (CT) revealed what appeared to be right ovary cancer with a secondarily perforated appendix or a ruptured malignant mucinous neoplasm of the appendix and multiple uterine myomas (Figures 1A and 1B). Ultrasonography revealed multiple uterine myomas. An exploratory laparotomy revealedmultiple abscesses in the omentumand a periappendiceal abscess involving the cecum and terminal ileum. At surgery, no tumor-likemasswas seen in the omentum, ovary, or any pelvicorgan.Thereweremultipleomentalabscesses.

Thermal Bowel Injury During Difficult Laparoscopic Myomectomy

A 38-year-old woman underwent a difficult laparoscopic myomectomy for multiple myomas with a uterus size of 24 weeks and complaints of heavy menstrual bleeding and severe dysmenorrhea. She had previously undergone laparoscopic myomectomy for a single large myoma. Intraoperatively, the patient had 9 submucosal myomas, which were resected hysteroscopically, and dense bowel adhesions to the uterus and anterior abdominal wall (Fig. 1a), which were released using scissors and bipolar forceps, and then proceeded with laparoscopic myomectomy. She received 2 units of packed cell transfusion. The postoperative period was eventful, with persistent abdominal distension and low grade fever with reactive basal pleural effusion. On postoperative day 5, we posted her for diagnostic laparoscopy, suspecting a bowel injury. She had localized peritonitis (Fig. 1b) with evidence of small bowel thermal injury and necrosis (Fig. 1c). We performed laparoscopic-assisted wide bowel resection (Fig. 1d) and an end-to-end anastomosis, with intensive care monitoring and electrolyte correction. The patient recovered on postoperative day 10 and was discharged in a healthy condition.

An Exceptional Case of Complete Septate Uterus With Unilateral Cervical Aplasia (Class U2bC3V0/ESHRE/ESGE Classification) and Isolated Mullerian Remnants: Combined Hysteroscopic and Laparoscopic Treatment

Study ObjectiveTo report the combined hysteroscopic and laparoscopic treatment of a complete septate uterus with unilateral cervical aplasia (class U2bC3V0/ESHRE/ESGE classification) and isolated mullerian remnants. DesignStep-by-step presentation of the surgical treatment (Canadian Task Force classification 4). SettingComplete septate uterus with unilateral cervical aplasia (formally Robert's uterus) is characterized by the presence of a uterine septum completely dividing the endometrial cavity into an obstructed hemicavity and a contralateral nonobstructing hemicavity connected normally to the existing cervix. It has always been described as isolated without any associated anomaly. PatientA 30-year-old woman was referred to our department for dysmenorrhea and primary infertility. Hysterosalpingography showed the presence of a right (RT) hemiuterus with a patent fallopian tube; further evaluation with 2- and 3-dimensional ultrasound and magnetic resonance imaging showed an externally normal-appearing uterus, a right normal hemicavity connected normally with the existed cervix and, a left hemicavity fully divided from the right one by a complete septum and not connected with the cervix. Interestingly, a peculiar complex mass with cystic areas, attached posterolaterally from the left side to the uterine wall at the level of the isthmus and the upper cervix, was also diagnosed. InterventionsThe study protocol was approved by our local institutional review board. During outpatient hysteroscopy, a right uterine hemicavity with a single ostium was identified without any communication with the left hemicavity. The patient was then scheduled for combined laparoscopic and hysteroscopic treatment. During laparoscopy, a normal uterine body with multiple myomas and a pseudocystic lesion attached posteriorly and left laterally to the uterus at the level of the isthmus and the upper cervix were shown; no communication between the cystic part of that lesion and the isthmus or the cervicovaginal canal was observed. During hysteroscopy, a longitudinal incision of the septum with a 5F bipolar electrode was performed; the left hemicavity was opened, and the corresponding tubal ostium was identified. The pseudocystic lesion was then excised after opening and sent for pathological analysis; the defect was closed with interrupted intracorporeal knots. Measurements and Main ResultsA single normal endometrial cavity with both tubal ostia was obtained, thus restoring obstruction by unification of the uterine cavity. A histologic report of the removed pseudocystic lesion was compatible with the diagnosis of mullerian remnants. A follow-up hysteroscopy 3 months after showed a normal uterine cavity without postsurgical adhesions. ConclusionThe use of 3-dimensional ultrasound and magnetic resonance imaging in combination with the new ESHRE/ESGE classification system gives the opportunity to obtain a precise representation of the female genital anatomy even in the presence of complex anomalies. Although a septate uterus with unilateral cervical aplasia has been already described, the presence of mullerian remnants is a rare entity associated with cyclic pelvic pain, thus needing adequate recognition and treatment. The combined hysteroscopic and laparoscopic approach offers a unique opportunity for the treatment of complex anomalies.

Minimally invasive management of 14–16-week abdominal ectopic with hemoperitoneum: an emergency laparoscopic procedure

Since the first laparoscopic cholecystectomy on a pregnant lady in 1991, a plethora of articles and case studies have been published addressing laparoscopy and their role in pregnancy. The Royal College of Obstetricians and Gynecologists Green-top Guidelines recommends laparoscopic surgery as the preferred approach in early ectopic tubal pregnancies. Laparoscopic versus laparotomy management of abdominal ectopic is a traumatic experience both on physical and emotional levels. The case study was a 36-year-old gravida 2 para 0 patient, previously normal pregnant lady, in which the follow-up ultrasound revealed moderate hemoperitoneum at 14–16 weeks of gestation. Upon urgent diagnostic laparoscopy, massive hemoperitoneum was detected despite no clinical signs of hemodynamic instability. Uterus was found to be within the normal measurements consistent with the nonpregnant state. Multiple myomas were clearly seen in the uterine wall. A fetus of 14–16 weeks was detected attached to the colon during formal laparoscopic pelvic and abdominal exploration for ectopic pregnancy. Operative laparoscopy for abdominal ectopic in skillful hands can be considered a feasible management technique carrying all the advantages of a minimally invasive procedure.

НОВІ ПОГЛЯДИ НА МЕХАНІЗМИ ПАТОГЕНЕЗУ ЛЕЙОМІОМИ МАТКИ.

&lt;p&gt; Етіологія та патогенез лейоміоми матки - вельми поширеної доброякісної пухлини жіночої репродуктивної системи залишаються не до кінця зрозумілими. Беручи до уваги велику роль місцевої ендокринної регуляції росту лейоміоми, було запропоновано можливу участь морфологічно нормального міометрія в її патогенезі. Спираючись на доведений факт несприятливого впливу множинної лейоміоми на частоту рецидивів, було проведено порівняльний аналіз експресії' імуногістохімічних&lt;br /&gt;маркерів у незміненому міометрії жінок з лейоміомою матки. За отриманими даними виділено два імуноморфотипи нормального міометрія у жінок з лейоміомою матки. Жінки з множинною лейоміомою мали статистично значуще збільшення експресії' ароматази, TSP-1 VEGF і підвищену судинну щільність (CD34) у незміненому міометрії.&lt;br /&gt;&lt;br /&gt;&lt;/p&gt;

Successful Myomectomy during Pregnancy for a Large Uterine Fibroid Causing Intestinal Obstruction: Report of a Case

Management of uterine fibroids during pregnancy is usually expectant making myomectomy a rather rare possibility. This is why surgical removal is generally delayed until after delivery. The current case was a large, symptomatic multiple uterine myomas causing pressure symptoms and was diagnosed during pregnancy by ultrasound and successfully managed by antepartum myomectomy retaining the fetus alive in utero at 18-20 weeks gestation. At term, the patient was delivered by Caesarian hysterectomy due to the presence of multiple myomas occupying the lower segment with placenta accrete, and uncontrolled blood loss from the placental bed. The patient remained uneventful till delivery. This case demonstrates the safety of myomectomy during pregnancy in special circumstances such as intestinal obstruction caused by external compression by a big fibroid. Key Words: Uterine fibroid, Antepartum, Myomectomy.

Large Parasitic Myoma Post Laparoscopic Subtotal Hysterectomy with Morcellation: Case Report and Literature Review

Abstract Background: Parasitic myomas comprise a rare manifestation of leiomyomas. The exact prevalence of parasitic myomas is unknown, and fewer than 100 cases have been previously reported in the literature. In recent years, there has been an increase in reports of parasitic myomas, the majority of which, following previous uterine operative procedures, are mainly myomectomy- or hysterectomy-related involving tissue morcellation. Case: A 46-year-old woman (gravida 5 para 4), presented with a large abdominal mass, diagnosed postoperatively as multiple parasitic myomas, with one of them being especially large, 8 years after a laparoscopic subtotal hysterectomy using tissue morcellation. She underwent an exploratory laparotomy. Pathologic findings confirmed the presence of leiomyoma. Results: The patient's post-operative hospitalization was uneventful, and she was discharged 3 days post operation. Conclusions: Postmorcellation parasitic myomas comprise an increasingly reported novel entity, which is most c...

A retrospective study of residual myomas following laparoscopic myomectomy

Abstract Background With the development of laparoscopic instruments such as the morcellator, a large number of gynecologists have performed laparoscopic myomectomies. In this study, we reviewed all cases in which residual myomas were identified by follow-up magnetic resonance imaging in order to evaluate why any myomas would remain after a laparoscopic myomectomy and to find their most common location and depth within the uterus. Methods Patients ( n = 128) with uterine myomas who underwent a laparoscopic myomectomy between 2008 and 2011 and received follow-up magnetic resonance imaging 3 months afterward were reviewed retrospectively. We analyzed the influence of preoperative gonadotrophin-releasing hormone agonist treatment, as well as the location and depth of the residual myomas within the uterus. The pregnancy rate in all cases was also investigated. Results The duration of the preoperative administration of gonadotrophin-releasing hormone agonist was statistically longer in cases where multiple residual myomas were found, compared with cases where a single residual myoma was present. There was no statistical difference in the rate and size of the residual myomas among five different locations within the uterus. The rate of residual subserosal myomas was lowest, compared with two other types, and was statistically lower than residual intramuscular myomas ( p Conclusion Because the completion of laparoscopic myomectomy without any residual myomas is difficult, informed consent regarding the possibility of their occurrence is necessary, regardless of the number of myomas detected preoperatively. Moreover, intramuscular residual myomas should be given particular attention due to their higher rate of incidence.