One aim of this article is to present 2 cases of parasitic myomas and 2 cases of leiomyomatosis peritonealis disseminata (LPD) after laparoscopic surgery with electrical morcellation. Other aims include reporting the current authors' incidence and reviewing the literature briefly.
Cases:
In these 4 cases, an electric tissue morcellator was used for myoma removal without any containment technique. All cases were symptomatic and 1 of them also presented with a 3-cm endometrioma nodule in the port site where the morcellator had been introduced in a previous surgery. All of the patients were young (< 40 years). No case of an unsuspected uterine sarcoma was seen.
Results:
The final histopathology was benign in all cases. Currently, all patients are asymptomatic.
Conclusions:
Laparoscopic morcellation of myomas without containment techniques is associated with an increased risk of parasitic myomas or LPD, mainly in reproductive-age women. Techniques for contained morcellation of the uterine tissue should be performed in an attempt to prevent this complication.
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References
1.
SteinerRA, WightE, TadirY, HallerU. Electrical cutting device for laparoscopic removal of tissue from the abdominal cavity. Obstet Gynecol, 1993; 81:471.
2.
U.S. Food and Drug Administration (FDA). FDA Discourages Use of Laparoscopic Power Morcellation for Removal of Uterus or Uterine Fibroids. April17, 2014. Online document at: www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm393689.htm Accessed June2, 2016.
3.
U.S. Food and Drug Administration (FDA). UPDATED Laparoscopic Uterine Power Morcellation in Hysterectomy and Myomectomy: FDA Safety Communication. November24, 2014. Online document at: www.fda.gov/medicaldevices/safety/alertsandnotices/ucm424443.htm Accessed June2, 2016.
4.
OstrzenskiA. Uterine leiomyoma particle growing in an abdominal-wall incision after laparoscopic retrieval. Obstet Gynecol, 1997; 89(5[pt2]):853.
5.
Van der MeulenJF, PijnenborgJM, BoomsmaCM, VerbergMF, GeominiPM, BongersMY. Parasitic myoma after laparoscopic morcellation: A systematic review of the literature. BJOG, 2016; 123:69.
6.
CucinellaG, GraneseR, CalagnaG, SomiglianaE, PerinoA. Parasitic myomas after laparoscopic surgery: An emerging complication in the use of morcellator? Description of four cases. Fertil Steril, 2011; 96:e90.
7.
BrolmannH, TanosV, GrimbizisG, et al.Options on fibroid morcellation: A literature review. Gynecol Surg, 2015; 12:3.
8.
SinhaR, HegdeA, MahajanC, DubeyN, SundaramM. Laparoscopic myomectomy: Do size, number, and location of the myomas form limiting factors for laparoscopic myomectomy?. J Minim Invasive Gynecol, 2008; 15:292.
CohenSL, EinarssonJI, WangKC, et al.Contained power morcellation within an insufflated isolation bag. Obstet Gynecol, 2014; 124:491.
11.
AAGL [Advancing Minimally Invasive Gynecology Worldwide]. AAGL practice report: Morcellation during uterine tissue extraction. J Minim Invasive Gynecol, 2014; 21:517.
12.
AkdemirA, TaylanE, ZeybekB, ErgenogluAM, SendagF. Innovative technique for enclosed morcellation using a surgical glove. J Minim Invasive Gynecol, 2015; 22(6S[suppl]):S135.
13.
WuM-Y, DingD-C, ChuT-Y, HongM-K. “Contain before transaction, contain before manual morcellation” with a tissue pouch in laparoendoscopic single-site subtotal hysterectomy. Gynecol Minim Invasive Ther, 2016; 5:178.
14.
RimbachS, HolzknechtA, NemesC, OffnerF, CrainaM. A new in-bag system to reduce the risk of tissue morcellation: Development and experimental evaluation during laparoscopic hysterectomy. Arch Gynecol Obstet, 2015; 292:1311.
15.
TrivediPH, PatilSS, ParekhNA, GandhiAC, TrivediSP, AbreoMO. Laparoscopic morcellation of fibroid and uterus in-bag. J Obstet Gynaecol India, 2015; 65:396.
16.
PaulPG, ThomasM, DasT, PatilS, GargR. Contained morcellation for laparoscopic myomectomy within a specially designed bag. J Minim Invasive Gynecol, 2016; 23:257.
17.
NezhatC, KhoK. Iatrogenic myomas: New class of myomas?. J Minim Invasive Gynecol, 2010; 17:544.
18.
Al-TalibA, TulandiT. Pathophysiology and possible iatrogenic cause of leiomyomatosis peritonealis disseminata. Gynecol Obstet Invest, 2010; 69:239.
19.
MiyakeT, EnomotoT, UedaY, et al.A case of disseminated peritoneal leiomyomatosis developing after laparoscope-assisted myomectomy. Gynecol Obstet Invest, 2009; 67:96.
20.
OrduluZ, Dal CinP, ChongWW, et al.Disseminated peritoneal leiomyomatosis after laparoscopic supracervical hysterectomy with characteristic molecular cytogenetic findings of uterine leiomyoma. Genes Chromosomes Cancer, 2010; 49:1152.
21.
TakedaA, MoriM, SakaiK, MitsuiT, NakamuraH. Parasitic peritoneal leiomyomatosis diagnosed 6 years after laparoscopic myomectomy with electric tissue morcellation: Report of a case and review of the literature. J Minim Invasive Gynecol, 2007; 14:770.
22.
WuYT, WuY, ChenSC, et al.A novel molecular cytogenetic finding of leiomyomatosis peritonealis disseminata. Gynecol Obstet Invest, 2015;April 23:e-pub ahead of print.
23.
YuriT, KinoshitaY, YukiM, YoshizawaK, EmotoY, TsuburaA. Leiomyomatosis peritonealis disseminata positive for progesterone receptor. Am J Case Rep, 2015; 16:300.
24.
RiekerRJ, AgaimyA, MoskalevEA, et al.Mutation status of the mediator complex subunit 12 (MED12) in uterine leiomyomas and concurrent/metachronous multifocal peritoneal smooth muscle nodules (leiomyomatosis peritonealis disseminata). Pathology, 2013; 45:388.
25.
Tan-KimJ, HartzellKA, ReinschCS, et al.Uterine sarcomas and parasitic myomas after laparoscopic hysterectomy with power morcellation. Am J Obstet Gynecol, 2015; 212:594.e1.
