Parasitic pedunculated fibroid. is laparoscopic management the best approach?

摘要

Parasitic myomas occur spontaneously when pedunculated subsero-sal myomas lose their blood supply from the uterus. They can also occur following previous myoma surgery (Kho and Nezhat 2009) or preoperative gonadotropin-releasing hormone (GnRH) agonist therapy (Brody 1953). We report the laparoscopic management of a large pedunculated fundal myoma, which was densely adherent to small bowel, gallbladder and liver and discuss the role of laparoscopy in the management of all pedunculated myomas. A 38-year-old woman presented with a history of subfertility and generalised abdominal pain. An ultrasound scan showed a pedunculated myoma measuring 124 mm × 112 mm × 79 mm. The uterus was enlarged by three further small subserous fibroids and both ovaries were normal. She had a previous emergency caesarean section. She was given subcutaneous goserelin (Zoladex?) 3.6 mg monthly for 3 months before elective admission for laparoscopic myomectomy. A standard closed subcostal laparoscopic entry was made at Palmer's point using a Veress needle (Rocket Medical, Washington, UK) and an optical 5 mm ENDOPATH? XCEL? Bladeless Trocar (Ethicon Endo-Surgery, Cincinnati, OH, USA). A 10 mm port was inserted intra-umbilicalry under direct vision and two further 5 mm ENDOPATH? XCEL? Bladeless Trocar ports were inserted laterally on the right and left side respectively.