[Long-term complication of laparoscopic uterine morcellation: iatrogenic parasitic myomas]

Abstract

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.

Keywords: Atypical myoma; Laparoscopic morcellation; Morcellateur; Morcellation cœlioscopique; Morcellator; Myome atypique; Myome parasitique; Parasitic myoma.