FCV-205 Laparoscopic excision of multiple parasitic pelvic and subdiaphragmatic fibroids.

Background:

Parasitic fibroids are a rare occurrence reported at 0.12% when a fibroid nodule acquires its major blood supply from adjacent structures and surviving on the new blood supply. In further studies, prevalence was found to be 0.9 and 1.2 %, primarily attributed to iatrogenic factors related to the growing use of morcellation without a containment bag in laparoscopic surgeries for uterine fibroids.(1)

Method:

We present a video record for a 41-year-old patient undergoing laparoscopic hysterectomy for heavy menstrual bleeding following failed conservative and surgical management. She had a previous laparoscopic myomectomy 5 years ago and had been often complaining of pinching pain in her lower chest on breathing for the past 2 years. An incidental finding of multiple small parasitic fibroids in the pelvis region, notably in the Pouch of Douglas and a larger subdiaphragmatic fibroid forming an adhesion band with the liver capsule.

This video illustrates a secure laparoscopic technique for:

1-Excision of the fibroids in the Pouch of Douglas.

2- Adhesiolysis around the subdiaphragmatic fibroid and its excision and retrieval.

Discussion:

This case emphasizes the risks associated with morcellation of fibroids without a containment bag, showcasing the potential for parasitic fibroid implantation in the abdominal cavity, leading to diverse symptoms based on its location. Despite these risk, laparoscopic management is a safe approach.

Conclusion

The presented video demonstrates a secure laparoscopic methodology for excising both pelvic and subdiaphragmatic parasitic fibroids. The findings propose this approach for adoption by gynaecology surgeons.

Referrence:

Cucinella G,Granese R, Calagna G, et al. Parasitic myomas after laparoscopic surgery: an emergency complication in the use of morcellator? Description of four cases. Fertil Steril. 2011;96(2) e90-96.