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Disseminated peritoneal leiomyomatosis: a devastating sequelae of unconfined laparoscopic morcellation
Hwee Leong Tan1, Ye Xin Koh1, Min Hoe Chew2,3,4
1Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore.
Abstract:
There has been growing concern surrounding the use of unconfined power morcellation in laparoscopic surgeries for uterine leiomyoma due to its associated risks and long-term clinical sequelae, including parasitic leiomyomas and disseminated peritoneal leiomyomatosis (DPL). We present a case of DPL resulting from previous laparoscopic morcellation and a review of the existing literature. DPL is a potentially devastating consequence of unconfined laparoscopic morcellation in the surgical management of uterine fibroids. A multidisciplinary approach is recommended in the management of DPL, especially in cases of multivisceral involvement. Clinical caution ought to be exercised when using power morcellators; when unavoidable, confined laparoscopic morcellation offers a promising mitigation and should be adopted if practicable.
Insights
Unconfined power morcellation during laparoscopic surgery for uterine fibroids can lead to disseminated peritoneal leiomyomatosis (DPL). Confined morcellation is a safer alternative to mitigate this risk.
Area of Science:
- Gynecologic surgery
- Surgical pathology
Background:
- Growing concerns exist regarding unconfined power morcellation in laparoscopic surgery for uterine leiomyoma.
- Associated risks include parasitic leiomyomas and disseminated peritoneal leiomyomatosis (DPL).
Observation:
- This report details a case of DPL following laparoscopic morcellation.
- A review of current literature on DPL is presented.
Findings:
- Disseminated peritoneal leiomyomatosis (DPL) is a severe potential outcome of unconfined laparoscopic morcellation for uterine fibroids.
- Management of DPL, particularly with multivisceral involvement, necessitates a multidisciplinary approach.
Implications:
- Clinical use of power morcellators requires caution.
- Confined laparoscopic morcellation should be adopted when feasible to reduce DPL risks.
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