Laparoscopic resection of a symptomatic parasitic leiomyoma of paravesical and obturator fossa.

OBJECTIVE: To show laparoscopic management of a symptomatic parasitic leiomyoma of paravesical and obturator fossa.

DESIGN: Edited video demonstrating a step by step explanation of the surgical technique of this case.

SETTING: A university hospital.

INTERVENTION: Uterine leiomyomas are the most common benign pelvic tumors in women. They occur in approximately 25% of women of reproductive age. Parasitic leiomyomas are rare, with few cases reported in the literature[1,4]. They are classified according to their location in relation to the myometrium. Parasitic leiomyomas are in group 8 of FIGO classification [2]. It is not clear why they are produced, it is thought that they could derive from subserous leiomyomas that achieved a blood supply from neighboring structures outside the uterus[1,2]. They can also have iatrogenic origin in patients who have undergone previous surgery like myomectomies with power morcellation use [3]. We present the case of a 32 years old women, gravida1, para 1. Without previous pelvic surgery. She complained of lower back and sacrum pain and nonspecific discomfort in the inner thigh. Her physical exam shows a 6-7 cm solid right paravaginal tumor. Ultrasonography and nuclear magnetic resonance confirm the presence of a 7 × 5 cm solid tumor in the right paravesical and obturator fossa. The diagnosis of probable parasitic myoma is proposed and a laparoscopic resection was scheduled. The video demonstrates the surgical technique with special emphasis on the anatomy of the surgical site. The patient was discharged at 24hr without complications. The final pathology confirmed uterine leiomyoma. Written informed consent was requested according regulations of our institution.

CONCLUSION: A successful laparoscopic resection of a symptomatic parasitic leiomyoma of the paravesical and obturator fossa is achieved. The importance of knowledge of pelvic anatomy for the management of this type of cases is underlined.