Parasitic myoma after laparoscopic morcellation: a systematic review of the literature

Abstract

Background Laparoscopic morcellation is frequently used for tissue removal after laparoscopic hysterectomy or myomectomy and may result in parasitic myomas, due to seeding of remained tissue fragments in the abdominal cavity. However, little is known about the incidence and risk factors of this phenomenon.Objectives To identify the incidence and risk factors for the development of parasitic myoma after laparoscopic morcellation.Search strategy A systematic review of the literature in Pubmed (MEDLINE) and Embase was conducted. Reference lists of identified relevant articles were checked for missing case reports.Selection criteria Studies reporting on incidence or cases of parasitic myoma diagnosed after laparoscopic morcellation were selected. Studies were excluded when history of laparoscopic morcellation was lacking or final pathology demonstrated a malignancy or endometriosis.Data collection and analysis Data were extracted and analysed on incidence of parasitic myomas and characteristics of case reports.Main results Fourty-four studies were included. Sixty-nine women diagnosed with parasitic myomas after laparoscopic morcellation were identified. Mean age was 40.8 (AE 7.5) years (range 24-57), median time between surgery and diagnosis was 48.0 months (range 1-192) and mean number of parasitic myomas was 2.9 (AE 3.3) (range 1-16). The overall incidence of parasitic myomas after laparoscopic morcellation was 0.12-0.95%.Conclusion Although the incidence is relatively low, it is important to discuss the risk of parasitic myoma after laparoscopic morcellation with women and balance towards alternative treatment options. The duration of steroid exposure after laparoscopic morcellation might be a risk factor for development of parasitic myomas.

Review of the literature on laparoscopic supracervical hysterectomy and related complications with single institution experience

“…A study by Van Der Meulen et al identified 69 patients who developed new, parasitic myomas resulting from morcellation. The risk for such complication has been estimated at 0.1-0.9% [34]. Other authors emphasize the possibility of spreading previously undiagnosed sarcoma or endometrial cancer.…”

Parasitic Leiomyomas Following Laparoscopic Myomectomy

“…5,12 This rate is much higher than the prevalence of uterine sarcoma, the focus of the U.S. Food and Drug Administration's statement discouraging the use of laparoscopic power morcellators in 2014. 13 New techniques have emerged to improve the safety of tissue extraction including manual or power morcellation within a containment bag.…”

“…1 Although little is known about the incidence and risk factors of this condition, it is presumed to originate from pedunculated fibroids that spontaneously detach from the uterus and obtain an alternative blood supply from adjacent organs. 2,5 In recent decades, however, an increase in the development and use of minimally invasive techniques has led to a potential iatrogenic origin of parasitic leiomyoma. The inadvertent dissemination of tissue fragments during laparoscopic surgical maneuvers, tissue manipulation, and extraction procedures creates the potential for fibroids to parasitize to extrauterine sites.…”

Oestrogen-Induced Angiogenesis and Implantation Contribute to the Development of Parasitic Myomas after Laparoscopic Morcellation

“…PMs largely occurred in the dependent part of the abdominal cavity, including intestines, peritoneum, omentum and port sites, and received abundant blood supply [8,[10][11][12][13][14][15][16][17]. Most women (78.3 %) presented with symptoms, such as abdominal or pelvic pain, dyspareunia, abdominal distension, abdominal pressure, urinary frequency and constipation [13,14,[17][18][19][20][21][22][23]. In 10.1 % patients, debulking procedure, such as omentectomy, appendectomy, or bowel resection, was necessary to eliminate all PMs [18,24,25].…”

“…Most women (78.3 %) presented with symptoms, such as abdominal or pelvic pain, dyspareunia, abdominal distension, abdominal pressure, urinary frequency and constipation [13,14,[17][18][19][20][21][22][23]. In 10.1 % patients, debulking procedure, such as omentectomy, appendectomy, or bowel resection, was necessary to eliminate all PMs [18,24,25]. Thus, it is important to elucidate the pathophysiology of laparoscopic morcellator-induced PMs.…”