Robotic-assisted Total Laparoscopic Hysterectomy Research Articles

Key techniques for difficult bladder dissection during robotic assisted total laparoscopic hysterectomy

Key techniques for difficult bladder dissection during robotic assisted total laparoscopic hysterectomy

Validate robot-assisted total laparoscopic hysterectomy with four equally-spaced ports without an assistant port.

To evaluate the usefulness of robot-assisted total laparoscopic hysterectomy with four equally-spaced ports (RA-TLH/4e) without an assistant port. In RA-TLH/4e, four da Vinci ports were placed horizontally at a height of 4cm above the umbilicus with 8cm equal spacing. Poor development of the surgical field or difficult forceps manipulations were handled with the endoscope and forceps movement (port-hopping). Patient background, surgical outcomes, complications, port-hopping frequency were compared in three groups: RA-TLH/4e, RA-TLH with four unequally-spaced ports (RA-TLH/4u), and conventional RA-TLH with five ports (RA-TLH/5). There were no significant differences in patient background or surgical outcomes among the three groups except for age, preparation time, and hospital stay, and no cases of laparotomy conversion or serious complications. RA-TLH/4e had fewer port-hoppings than RA-TLH/4u. The minimum abdominal width showed a weak negative correlation with port-hopping frequency in RA-TLH/4u, but not in RA-TLH/4e. RA-TLH/4e allowed for a reduction in personnel and costs compared to RA-TLH/5. The equal placement of four ports allowed sufficient port spacing even for patients with narrow abdominal widths. In addition, the port-hopping technique was able to fully compensate for the lack of an assistant port. RA-TLH/4e is a highly useful technique that not only excels in safety but also reduces costs.

First report of robotic-assisted total hysterectomy using the Hugo™ RAS system.

This study describes the first reported treatment of a benign gynecological disease with the Medtronic's Hugo™ RAS System, the first robot-assisted device used in the field of gynecology in Japan. Patients who underwent robot-assisted total laparoscopic hysterectomy with the Hugo™ RAS System at the Tottori University Hospital between March 2023 and June 2023 were included in this study. In the first case, the patient was in her 40s and had uterine fibroids. We describe our experience and compare the device with the conventional da Vinci surgical system. We discuss the key features of the Hugo system (including the independent arms, open console, and pistol-shaped handle), the convenience of robotic surgery, the potential to improve quality of life, and how this technology could revolutionize the field of surgery.

Multimodal pain management after robotic-assisted total laparoscopic hysterectomy reduces postoperative opioid use and pain scores (1180)

Multimodal pain management after robotic-assisted total laparoscopic hysterectomy reduces postoperative opioid use and pain scores (1180)

Success Rates of Sentinel Lymph Node Mapping for Endometrial Cancer in Patients with Body Mass Index < 45 Compared with Body Mass Index ≥ 45

The objective is to evaluate the rate of sentinel lymph node (SLN) mapping in patients with body mass index (BMI [kg/m2]) BMI ≥ 45 compared with < 45. A retrospective chart review. Three urban referral-based settings-1 academic and 2 community based. Patients age ≥ 18 years, with endometrial intraepithelial neoplasia or clinical stage 1 endometrial cancer who underwent robot-assisted total laparoscopic hysterectomy with attempted SLN mapping between January 2015 and December 2021. Robot-assisted total laparoscopic hysterectomy with attempted SLN mapping. A total of 933 subjects were included: 795 (85.2%) with BMI < 45 and 138 (14.8%) with BMI ≥ 45. Comparing the BMI < 45 with BMI ≥ 45 group, bilateral mapping was successful in 541 (68.1%) vs 63 (45.7%), respectively. Unilateral mapping was successful in 162 (20.4%) vs 33 (23.9%), respectively. Failure to map occurred in 92 (11.6%) vs 42 (30.4%) (p <.001), respectively. Exploratory analysis also suggested an inverse relationship between success rate of bilateral SLN mapping and BMI, with patients with BMI < 20 having bilateral SLN mapping rates of 86.5% and patients with BMI ≥ 61 having rates of 20.0%. The steepest decline in bilateral SLN mapping rates was from BMI group 46 to 50 compared to 51 to 55, at 55.4% to 37.5%, respectively. Adjusted odds ratio (compared with those with BMI < 30) for those in the BMI 30 to 44 group was 0.36 (95% confidence interval 0.21-0.60) and for those in the BMI ≥ 45 group was 0.10 (95% confidence interval 0.06-0.19). There is a statistically significant lower rate of SLN mapping in patients with a BMI ≥ 45 than BMI < 45. Understanding the success of SLN mapping in patients with morbid obesity is essential for preoperative counseling, surgical planning, and developing a risk-appropriate postoperative treatment plan.

Robotic-assisted total laparoscopic hysterectomy and excision of endometriosis in a patient with uterus didelphys

Robotic-assisted total laparoscopic hysterectomy and excision of endometriosis in a patient with uterus didelphys

Robotic-assisted total laparoscopic hysterectomy in a patient with a history of a lefort colpocleisis: tips and tricks for performing a hysterectomy without a manipulator

Robotic-assisted total laparoscopic hysterectomy in a patient with a history of a lefort colpocleisis: tips and tricks for performing a hysterectomy without a manipulator

Excision of triple compartment deep infiltrating endometriosis with visceral involvement

Background: Excision of multi-compartment deep infiltrating endometriosis with visceral involvement is challenging. We illustrate an interdisciplinary approach to complete minimally invasive excision in a single surgery. Case: We present a case of deep infiltrating endometriosis with visceral involvement in the anterior, middle, and posterior compartments. A collaborative surgical approach was taken with gynecologic, colorectal, and urologic surgeons to perform a robot-assisted total laparoscopic hysterectomy, bilateral salpingectomy, ovarian cystectomy, and unilateral oophorectomy with concurrent segmental resection of rectosigmoid and excision of transmural bladder and vaginal nodules. Conclusion: Thorough preoperative evaluation and an interdisciplinary approach to surgical planning involving radiology, gynecology, colorectal surgery, and urology allowed for complete simultaneous resection of bladder, rectosigmoid, and pelvic deep infiltrating endometriosis without complications via a minimally invasive route.

8665 Minimally Invasive Surgical Management of Placental Site Trophoblastic Tumor

<h3>Study Objective</h3> We present a unique case of presumed stage 1 placental site trophoblastic tumor (PSTT) with an incidental pancreatic mass noted on MRI. A minimally invasive surgical approach was planned in combination between gynecologic oncology and surgical oncology. <h3>Design</h3> Single patient case report. <h3>Setting</h3> Academic quaternary care hospital. <h3>Patients or Participants</h3> A 31-year-old G4P0131 was diagnosed with PSTT four months following a spontaneous abortion. Her preoperative evaluation included a β-hCG which plateaued at 80 milliunits/mL, magnetic resonance imaging with a 2 cm mass in the body of the pancreas, and no other evidence of metastatic disease. The pancreatic mass had imaging characteristics suggestive of a pseudopapillary neoplasm of the pancreas. Patient declined preoperative upper endoscopic ultrasound with biopsy. Due to the presumed low malignant potential of the pancreatic lesion and low likelihood of metastatic disease to the pancreas, she was deemed low-risk with a WHO score of 3. She had completed childbearing and surgical management with hysterectomy was recommended. <h3>Interventions</h3> A combined robotic assisted total laparoscopic hysterectomy and laparoscopic distal pancreatectomy and splenectomy. <h3>Measurements and Main Results</h3> The patient was discharged home on postoperative day three after the above procedure and had an uncomplicated postoperative course. Final pathology revealed a metastatic implant in the pancreas. The patient has since completed adjuvant chemotherapy with EMA/CO. β-hCG down trended to within normal limits and the patient currently has no evidence of disease. <h3>Conclusion</h3> We present a case of a rare tumor with an unusual metastatic pattern. Given its rarity, minimally invasive surgical management should remain the standard for low risk PSTT. However, preoperative biopsy could be beneficial with unusual imaging findings as high risk PSTT requires chemotherapeutic management.

Cervical Fibroids - Key Surgical Steps

<h3>Study Objective</h3> To review critical steps during robotic assisted total laparoscopic hysterectomy in patients with large cervical fibroids, focusing on tips for safely performing ureterolysis, isolation of uterine vasculature, and colpotomy. <h3>Design</h3> Stepwise demonstration of the technique with narrated video footage. <h3>Setting</h3> Surgery is the primary therapy for cervical leiomyomas, which account for 0.6-2% of uterine fibroids. Cervical fibroids significantly alter anatomy, making a minimally invasive approach prohibitive to many providers. The size and location of the fibroid can cause alterations in ureter course and uterine vasculature, inability to use a uterine manipulator, and deformation of the colpotomy. <h3>Patients or Participants</h3> The first case depicts a patient with a 7.9-cm, midline, cervical fibroid. She received preoperative Leuprolide twice, resulting in a decrease in maximum diameter to 5.5 cm intra-operatively. The second case demonstrates a patient with a 13-cm cervical fibroid on imaging, noted to be at least 15 cm intra-operatively, causing bilateral hydroureters and hydronephrosis. <h3>Interventions</h3> This video demonstrates how to navigate the main challenges afforded by cervical fibroids when performing robotic hysterectomy. It includes how to create the space needed for ureterolysis and demonstrates using the ureter as a tool for navigation in the altered retroperitoneum. It highlights the importance of ligating the uterine arteries at their origin and reflecting the uterine arteries from medial to lateral. Finally, it reviews tips for completing a colpotomy using an end-to-end anastomosis (EEA) sizer as a guide and dynamic tool. <h3>Measurements and Main Results</h3> Both patients did well postoperatively with resolution of their symptoms. The second case had complete resolution of hydroureters and hydronephrosis. <h3>Conclusion</h3> Surgery is the primary therapy for cervical leiomyomas. A minimally invasive approach has proven benefits over open surgery but poses challenges due to distortion of normal anatomy. In the appropriate patient with a large cervical fibroid, robotic and laparoscopic hysterectomy can safely be performed by a skilled minimally invasive surgeon.

8802 GYN 101: Introduction to Uterine Manipulators

<h3>Study Objective</h3> To understand the insertion techniques and use of various types of uterine manipulators. <h3>Design</h3> This video highlights the importance behind the use of manipulators during laparoscopy and identifies unique aspects of various types of manipulators. Additionally, we review how to properly insert and use manipulators. <h3>Setting</h3> The patient is placed in dorsal lithotomy for the video. <h3>Patients or Participants</h3> One patient is filmed to demonstrate the placement of a Fornisee manipulator for a robotic assisted total laparoscopic hysterectomy. A combination of simulation models and photographs were also utilized to review educational topics. <h3>Interventions</h3> The utility of manipulators during laparoscopy, various types of manipulators, and proper insertion techniques are reviewed. <h3>Measurements and Main Results</h3> We review how uterine manipulators assist with visualization, elevate the uterine vessels farther away from the ureters and bladder, and delineate the cervicovaginal junction assisting with colpotomy. Many manipulators have unique aspects that make them favored for specific clinical situations. This video demonstrates how extracorporeal hand movements position the uterus in an opposite fashion intra-abdominally. <h3>Conclusion</h3> It is important to know different manipulator types to tailor their use to specific clinical scenarios. Safe and accurate placement and proper movements are crucial in assisting the surgeon, especially during important dissection steps.

Deep Infiltrating Endometriosis Affecting Ileoanal Anastomosis (J-Pouch): Surgical Approach

<h3>Study Objective</h3> To review a patient case of deep infiltrating endometriosis of an ileoanal anastomosis. <h3>Design</h3> Case report. <h3>Setting</h3> Academic institution, Minimally Invasive Gynecologic Surgery and Colorectal combined procedure. <h3>Patients or Participants</h3> 38-year-old with history of ulcerative colitis status post ileoanal anastomosis (J-pouch) with deep infiltrating endometriosis. <h3>Interventions</h3> Robotic-assisted total laparoscopic hysterectomy with bilateral salpingectomy, left oophorectomy, excision of deep infiltrating endometriosis of J-pouch, ureteral ICG injection, and pouchoscopy. <h3>Measurements and Main Results</h3> Patients with endometriosis are at increased risk of co-morbid inflammatory bowel disease. Ileoanal anastomosis is indicated in patients with disease affecting the entire colon and rectum such as ulcerative colitis. The J-pouch is created with an anastomosis of folded terminal ileum following total resection of the colon and rectum. An enterotomy of the pouch and anal anastomosis are then completed, forgoing the need for ileostomy. The primary vascular supply consists of terminal branches of the superior mesenteric artery and is therefore limited. The patient presented with pain and on MRI was found to have deep infiltrating endometriosis of the ileoanal anastomosis approximating 3.2 by 1.0 cm, as well as a left endometrioma. Intra-operatively, the deep infiltrating lesion was identified on the efferent limb on the antimesenteric border of the J-pouch ileum and removed using a shave technique. Care is taken to avoid the vascular supply to the J-pouch on the mesenteric aspect, as no collateral supply is available. An omental pedicle flap was created and secured overlying the pouch to reduce the risk of fistula formation. The patient underwent the procedure without complications. <h3>Conclusion</h3> Patients with endometriosis are at increased risk of comorbid inflammatory bowel disease. Knowledge of J-pouch anatomy is crucial to dissection in cases of endometriosis involvement, including delicate blood supply. The use of an omental flap can be helpful to prevent formation of future adhesions. A multidisciplinary approach is key to patient care.

Ureterolysis for Deep Infiltrating Endometriosis Using Indocyanine Green on the Robotic Platform

<h3>Study Objective</h3> To demonstrate safe identification of ureters in patients with deep infiltrating endometriosis or severe adhesive disease using indocyanine green under near-infrared fluorescence on the robotic platform. <h3>Design</h3> Stepwise demonstration using narrated video footage. <h3>Setting</h3> An academic tertiary care hospital. <h3>Patients or Participants</h3> A 43-year-old G0 with stage IV endometriosis presented with chronic pelvic pain. Her surgical history is notable for two aborted hysterectomies due to severe adhesive disease, despite extensive lysis of adhesions. She desired surgical intervention. <h3>Interventions</h3> In cases of stage IV endometriosis, localizing the ureters can be challenging due to severe adhesive disease, surrounding fibrotic tissue, and distorted anatomy. Intravenous indocyanine green has previously been described to assist with resection of endometriosis.^1-3 Alternatively, we describe a technique that allows for easier identification of ureters using indocyanine green (ICG) injection retrogradely in ureteral stents while visualized under near-infrared fluorescence (NIRF).^4-5 1. Perform cystoscopy and place bilateral open-ended 5-French ureteral catheters. Inject indocyanine green retrogradely in each ureteral catheter, and place caps to seal the catheters to maximize ICG retention. 2. Once robotic-assisted laparoscopic surgery is started, use NIRF to identify the ureter. The ureter will emit green fluorescence, whereas the surrounding tissue will not. 3. Once the ureter is identified, NIRF is intermittently used to safely follow the course of the ureter and perform ureterolysis, while excising endometriosis. <h3>Measurements and Main Results</h3> The patient underwent robotic-assisted total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, bilateral ureterolysis, low anterior bowel resection with primary anastomosis, and resection of endometriosis without intraoperative complications or ureteral injury. Her postoperative course was unremarkable. At her 3-week postoperative visit, pelvic pain had completely resolved. <h3>Conclusion</h3> This case demonstrates the use of intra-ureteral ICG and NIRF to identify the ureters and perform ureterolysis in cases of deep infiltrative endometriosis.

Erosion of calcified uterine leiomyoma into the urinary bladder: A case report

Introduction: Uterine leiomyomas are benign smooth muscle tumors that affect approximately 70–80% of women worldwide. Erosion of leiomyomas into surrounding tissues is a rare complication. We present a case of a postmenopausal female with uterine leiomyoma eroding into the urinary bladder. Case Report: A 55-year-old, postmenopausal female with history of uterine fibroids previously treated with uterine artery embolization presented with recurrent bladder stones, hematuria, and pelvic pain. Pelvic magnetic resonance imaging described a 4.3 cm heterogenous mass involving the ventral uterine fundus and bladder dome concerning for malignancy. She underwent robotic-assisted total laparoscopic hysterectomy, right salpingo-oophorectomy, left salpingectomy, and partial bladder cystectomy. Pathology was significant for benign calcified leiomyoma and benign calcifications within the bladder mucosa. Conclusion: Erosion of leiomyoma through the bladder mucosa is rare complication but should be considered in the differential diagnosis for patients presenting with hypercalciuria and recurrent bladder stones in the setting of uterine fibroids previously treated with uterine artery embolization.

Early evaluation of a next-generation surgical system in robot-assisted total laparoscopic hysterectomy: A prospective clinical cohort study.

This study aimed to demonstrate the safe and effective use of the Versius surgical system (CMR Surgical, Cambridge, UK) in robot-assisted total laparoscopic hysterectomy. This surgical robot was developed iteratively with input from surgeons to improve surgical outcomes and end-user experience. We report data from the gynecology cohort of an early clinical trial designed in broad alignment with IDEAL-D (Idea, Development, Exploration, Assessment, Long-term follow-up - Devices) stage 2b (Exploration). The study is registered in the Indian clinical trials register (CTRI/2019/02/017872). Adult women requiring total hysterectomy who provided informed consent and met the eligibility criteria underwent procedures at one of three hospitals in India. Five surgeons performed robot-assisted total laparoscopic hysterectomies using the device from March 2019 to September 2020. The primary endpoint was rate of unplanned conversion to conventional laparoscopic or open surgery. Adverse events were adjudicated by an independent clinical events committee using endoscope video recordings and clinical notes. In total, 144 women underwent surgery (median age: 44 years [range: 28-78]; median body mass index 25.8 kg/m2 [range: 14.3-47.8]). The rate of unplanned conversion to conventional laparoscopy was 2/144 (1.4%); neither conversion was device related. No surgery was converted to open. In total, 13 adverse events occurred among seven (4.9%) patients, comprising seven serious adverse events and six adverse events. One serious adverse event was deemed device-related. Two patients were readmitted to hospital within 30 days; both made a full recovery. No patients died within 90 days of surgery. The device provides a safe and effective option for total laparoscopic hysterectomy; these findings support its continued implementation in larger patient cohorts and expansion in other major minimal access indications.

The Use of near Infra-Red Radiation Imaging after Injection of Indocyanine Green (NIR-ICG) during Laparoscopic Treatment of Benign Gynecologic Conditions: Towards Minimalized Surgery. A Systematic Review of Literature.

Background and Objectives: To assess the use of near infrared radiation imaging after injection of indocyanine green (NIR–ICG) during laparoscopic treatment of benign gynecologic conditions. Materials and Methods: A systematic review of the literature was performed searching 7 electronic databases from their inception to March 2022 for all studies which assessed the use of NIR–ICG during laparoscopic treatment of benign gynecological conditions. Results: 16 studies (1 randomized within subject clinical trial and 15 observational studies) with 416 women were included. Thirteen studies assessed patients with endometriosis, and 3 studies assessed non-endometriosis patients. In endometriosis patients, NIR–ICG use appeared to be a safe tool for improving the visualization of endometriotic lesions and ureters, the surgical decision-making process with the assessment of ureteral perfusion after conservative surgery and the intraoperative assessment of bowel perfusion during recto-sigmoid endometriosis nodule surgery. In non-endometriosis patients, NIR–ICG use appeared to be a safe tool for evaluating vascular perfusion of the vaginal cuff during total laparoscopic hysterectomy (TLH) and robotic-assisted total laparoscopic hysterectomy (RATLH), and intraoperative assessment of ovarian perfusion in adnexal torsion. Conclusions: NIR–ICG appeared to be a useful tool for enhancing laparoscopic treatment of some benign gynecologic conditions and for moving from minimally invasive surgery to minimalized surgery. In particular, it might improve treatment of endometriosis (with particular regard to deep infiltrating endometriosis), benign diseases requiring TLH and RATLH and adnexal torsion. However, although preliminary findings appear promising, further investigation with well-designed larger studies is needed.

Robotic-assisted Laparoscopic Ureterolysis for Deep Infiltrating Endometriosis using Indocyanine Green Under Near-Infrared Fluorescence

To demonstrate safe identification of ureters in patients with deep infiltrating endometriosis or severe adhesive disease using indocyanine green (ICG) under near-infrared fluorescence (NIRF) on the robotic platform. Stepwise demonstration using narrated video footage. An academic tertiary care hospital. A 43 year old G0 with stage IV endometriosis presented with chronic pelvic pain. Her surgical history is notable for 2 aborted hysterectomies due to severe adhesive disease, despite extensive lysis of adhesions. She desired surgical intervention. In cases of stage IV endometriosis, localizing the ureters can be challenging due to severe adhesive disease, surrounding fibrotic tissue, and distorted anatomy. Intravenous ICG has previously been described to assist with resection of endometriosis [1-3]. Alternatively, we describe a technique that allows for easier identification of ureters using ICG injection retrogradely in ureteral stents while visualized under NIRF [4,5]. The patient underwent robotic-assisted total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, bilateral ureterolysis, low anterior bowel resection with primary anastomosis, and resection of endometriosis without intraoperative complications or ureteral injury. Her postoperative course was unremarkable. At her 3 week postoperative visit, pelvic pain had completely resolved. This case demonstrates the use of intraureteral ICG and NIRF to identify the ureters and perform ureterolysis in cases of deep infiltrative endometriosis.

Robot-Assisted Total Laparoscopic Hysterectomy in Different Classes of Obesity: A Cohort Study

Background and Objectives:Robot-assisted laparoscopic hysterectomy is a safe and feasible approach in patients with higher body mass index (BMI). Slightly longer operating time in patients with high BMI did not result in higher complication or conversion rates. The purpose of this study was to evaluate whether robot-assisted total laparoscopic hysterectomy is a feasible and safe surgical approach in different classes of obesity.Methods:A single center retrospective cohort study was performed in a large secondary teaching hospital in the Netherlands. All patients who underwent robot-assisted total laparoscopic hysterectomy between January 1, 2011 and January 31, 2019 were included.Results:Data regarding patient characteristics, complication rate, conversion rate, skin-to-skin time, robot console time, and operating room time were collected. Surgery specific data were compared in patients with several classes of obesity. In total 356 cases were included. Median BMI was 29 kg/m2 (range 18 – 59). Complication rate and conversion to laparotomy did not differ significantly in different classes of obesity. Robot console time and skin-to-skin time was significantly longer in women with a BMI ≥ 40 kg/m2 (n = 34) compared to patients with normal BMI.Conclusion:Robot-assisted laparoscopic hysterectomy is a safe and feasible approach in women in different classes of obesity. The significantly prolonged operating time does not result in higher complication or conversion rates.

A Novel Camera Rotation Approach for a Robot-Assisted Total Laparoscopic Hysterectomy for Large Fibroid Uterus

<h3>Study Objective</h3> This video details a novel approach to camera rotation to better visualize adnexal structures with large intrapelvic mass during robotic-assisted total laparoscopic hysterectomy. <h3>Design</h3> No study design was formulated for this video. <h3>Setting</h3> This was performed in an inpatient facility. <h3>Patients or Participants</h3> One 48-year-old female. <h3>Interventions</h3> Robotic-assisted total laparoscopic hysterectomy with novel camera rotation approach. <h3>Measurements and Main Results</h3> The main result of this procedure was for patient to tolerate the procedure well while achieving the end goal of hysterectomy. <h3>Conclusion</h3> This is a feasible and highly reproducible process that may be adopted by other surgeons.

Parasitic Leiomyoma: A Rare Occurrence Following Robotic Hysterectomy

<h3>Study Objective</h3> To highlight the presentation and management of a symptomatic parasitic leiomyoma after a robotic assisted hysterectomy for a multi-fibroid uterus. <h3>Design</h3> Case report. <h3>Setting</h3> Lithotomy, Trendelenburg positioning. <h3>Patients or Participants</h3> C.B. is a 36-year-old G0. <h3>Interventions</h3> Index surgery – Robotic-assisted total laparoscopic hysterectomy and bilateral salpingectomy with mini-laparotomy 1. Robotic-assisted laparoscopic removal of pelvic mass <h3>Measurements and Main Results</h3> C.B. is a 36-year-old G0 who desired definitive management of a symptomatic multi-fibroid uterus. Preoperative ultrasound and MRI displayed an enlarged multi-fibroid 18-week uterus with a dominant 9cm fundal fibroid. Leuprolide acetate was administered for 6 months pre-operatively to reduce the myoma size and anticipated intra-operative blood loss. She underwent a robotic-assisted total laparoscopic hysterectomy and bilateral salpingectomy. A myomectomy was concurrently performed with diathermy to remove an obstructing fibroid for aid in visualization. A mini laparotomy was made to remove the surgical specimen, which was unable to be delivered through vagina. Pathology was benign. C.B. presented one year postoperatively with pelvic pain and bulk symptoms. Her exam was consistent with an adnexal mass and MRI revealed a 6cm pelvic mass. C.B. underwent a robotic-assisted laparoscopic removal of the mass, which was attached to the vaginal cuff. Pathology revealed an infarcted leiomyoma. She followed up postoperatively with complete resolution of her symptoms. <h3>Conclusion</h3> This case highlights a rare occurrence of a parasitic leiomyoma following a hysterectomy. There has been no publication to date describing the occurrence of parasitic myomas after concomitant myomectomy and hysterectomy without morcellation. The authors speculate that seeding of cells during the myomectomy may have been responsible for the development of a parasitic myoma; however, further investigation is needed. This case report also emphasizes the importance of being mindful of the occurrence of parasitic fibroids in a post-hysterectomy patient presenting with pain and pelvic mass.