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We report an interesting case of parasitic fibroid which developed from a morcellation remnant following laparoscopic myomectomy. The patient presented with incidental finding of pelvic mass in 2005. She underwent laparoscopic myomectomy for a myoma extending from the Pouch of Douglas to both sides of broad ligament. She subsequently presented with abdominal pain 3 years later in 2008. She underwent total laparoscopic hysterectomy with removal of broad ligament fibroids. During her hysterectomy, a right lumbar mass attached to the omentum was detected, which was excised laparoscopically. Histopathology of the mass confirmed it to be consistent with leiomyoma. This mass could probably be a morcellation remnant that has grown to this size taking blood supply from the omentum. We report this case to emphasize that all tissue pieces that are morcellated should be diligently removed. Even small bits displaced into the upper abdomen can result in parasitic fibroids. Thus, it can be concluded that parasitic myomas can arise from morcellated remnants and grow depending on the blood supply.

The aim of this study was to analyze the feasibility and technique of removing large submucous myomas laparoscopically. This technique decreases the complications of removing the submucous myoma hysteroscopically. The design was based on a retrospective review (Canadian Task Force Classification II-1) in a dedicated high volume gynecological laparoscopy centre. The subjects were twenty-two women who underwent laparoscopic removal of submucous myomas at our center. Laparoscopic removal of submucous myoma was done in all patients in whom the size of the myoma was more than 5 cm. The results revealed the following: (1) median clinical size of the uterus was 12 weeks (6, 18); (2) median size of the myoma was 7 cm (5, 10); (3) median weight of the specimen was 200 g (60, 460); (4) median total duration of surgery was 75 min (40, 120); (5) median total blood loss was 50 ml (10, 500); and the total morcellation time was 15 min (5, 45). Laparoscopic myomectomy for large submucous myomas is a technically feasible procedure. It can be performed by experienced surgeons irrespective of the size or depth of the myoma. It prevents the complications of hysteroscopic removal of the myoma.

Uterine leiomyomas are one of the most common benign smooth muscle tumors in women, with a prevalence of 20 to 40% in women over the age of 35 years. Although many women are asymptomatic, problems such as bleeding, pelvic pain, and infertility may necessitate treatment. Laparoscopic myomectomy is one of the treatment options for myomas. The major concern of myomectomy either by open method or by laparoscopy is the bleeding encountered during the procedure. Most studies have aimed at ways of reducing blood loss during myomectomy. There are various ways in which bleeding during laparoscopic myomectomy can be reduced, the most reliable of which is ligation of the uterine vessels bilaterally. In this review we propose to discuss the benefits and possible disadvantages of ligating the uterine arteries bilaterally before performing laparoscopic myomectomy.

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