Laparoscopic Transabdominal Preperitoneal Excision of a Leiomyoma

Abstract

Introduction:

Extrauterine leiomyomas in women without prior gynecologic or intestinal surgery are exceptionally rare. ^1,2 Most reports describe open surgical resection as treatment for these rare tumors. ³ In selected cases, however, a minimally invasive approach may be feasible.

Materials and Methods:

The patient is a 76-year-old woman with hypertension, obesity (body mass index 35 kg/m²), and a previous right knee replacement who was taken to the operating room for laparoscopic sigmoid colectomy for a large endoscopically unresectable polyp diagnosed on screening colonoscopy. Preoperative staging computed tomography revealed an incidental 3.9 × 4.2 × 4.8 cm lobulated, heterogeneous enhancing mass in the right lower quadrant. After completion of the laparoscopic sigmoid colectomy using a standard medial to lateral dissection technique and stapled coloproctostomy, we then performed a transabdominal preperitoneal excision of the pelvic mass.

Results:

The patient had an uneventful recovery and was discharged on postoperative day 3. At clinic follow-up, she was doing well without complaints. Surgical pathology revealed a 5 cm tubulovillous adenoma with focal high-grade dysplasia in the sigmoid colon in the background of eosinophilic colitis. The pelvic mass was consistent with a leiomyoma.

Conclusion:

This case highlights a minimally invasive approach for treatment of an extremely rare preperitoneal extrauterine/extraintestinal leiomyoma in a patient without prior gynecologic or intestinal surgery.

No competing financial interests exist

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Runtime of video: 4 mins 55 secs