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[Long-term complication of laparoscopic uterine morcellation: iatrogenic parasitic myomas]
B Rabischong1, M Beguinot, C Compan
1Service de gynécologie obstétrique et reproduction humaine, CHU de Clermont-Ferrand, CHU Estaing, gynécologie A, 1, place Lucie-Aubrac, 63100 Clermont-Ferrand, France.
Objectives:
Identify parasitic myomas following uterine laparoscopic morcellation and describe the circumstances of diagnosis, management, potential consequences and possible preventive measures.
Methods:
Retrospective study of observed cases in a university hospital between 2000 and 2012 and review of the literature.
Results:
Five cases were identified in our department. Pelvic pain was the main symptom in three patients while one was asymptomatic and one consulted for a cystocele. The average time to diagnosis was 88 months (3-192). Surgical removal was performed in four cases by laparoscopy and vaginally for one case. Histological examination showed typical leiomyomas, but in one case, an atypical leiomyoma with limited experience for a typical primary lesion. In the literature, there are about 50 cases. One required a bowel resection and for another one, after subtotal hysterectomy, histological examination showed complex atypical endometrial hyperplasia for normal endometrium initially.
Conclusions:
This study should draw the attention of laparoscopic surgeon. It emphasizes, beyond a potential reoperation, a risk of atypical histological secondary processing. Surgical resection should be discussed even in case of asymptomatic lesions.
