Gynecologic Oncology Unit, Department of Obstetrics and Gynecology (Drs. Paredes, Sagredo, and Herrera).
Gynecologic Oncology Unit, Department of Obstetrics and Gynecology (Drs. Paredes, Sagredo, and Herrera).
J Minim Invasive Gynecol. 2021 Jul;28(7):1277. doi: 10.1016/j.jmig.2020.08.485. Epub 2020 Sep 2.
To show laparoscopic management of a symptomatic parasitic leiomyoma of paravesical and obturator fossa.
Edited video demonstrating a step-by-step explanation of the surgical technique of this case.
University hospital.
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 [1,2]. They are classified according to their location in relation to the myometrium. Parasitic leiomyomas are in group 8 of the International Federation of Gynecology and Obstetrics classification [3]. 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 [1,3]. They can also have iatrogenic origin in patients who have undergone previous surgery such as myomectomy with power morcellation use [4]. We present the case of a 32-year-old women, gravida 1 para 1, without previous pelvic surgery. She complained of lower back and sacrum pain and nonspecific discomfort in her inner thigh. Her physical examination showed a 6- to 7-cm solid right paravaginal tumor. Ultrasonography and nuclear magnetic resonance confirmed the presence of a 7 × 5-cm solid tumor in the right paravesical and obturator fossa. The diagnosis of a probable parasitic myoma was 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 24 hours after surgery without complications. The final pathology confirmed uterine leiomyoma. Written informed consent was requested according to the regulations of our institution.
A successful laparoscopic resection of a symptomatic parasitic leiomyoma of the paravesical and obturator fossa was achieved. The importance of knowledge of the pelvic anatomy for the management of this type of case is underlined.
展示经腹腔镜处理症状性阔韧带和闭孔窝寄生性平滑肌瘤。
编辑视频，逐步讲解该病例的手术技术。
大学医院。
子宫平滑肌瘤是女性最常见的盆腔良性肿瘤，约 25%的育龄妇女会发生。寄生性平滑肌瘤少见，文献中报道的病例很少[1,2]。根据与子宫肌层的关系，它们分为不同类型。寄生性平滑肌瘤属于国际妇产科联合会（FIGO）分类的第 8 组[3]。其产生的原因尚不清楚，有人认为它们可能来源于子宫外邻近结构的浆膜下平滑肌瘤，获得了血液供应[1,3]。也可能与既往手术有关，如接受过使用电动旋切术的肌瘤切除术[4]。我们报告了 1 例 32 岁女性，初产妇，无盆腔手术史。她主诉下背部和骶骨疼痛，大腿内侧有非特异性不适。体格检查发现右侧阔韧带区有一个 6-7cm 的实性肿块。超声和磁共振成像证实右侧阔韧带和闭孔窝有一个 7×5cm 的实性肿瘤。考虑可能为寄生性平滑肌瘤，拟行腹腔镜切除术。该视频演示了手术技术，特别强调了手术部位的解剖结构。患者术后 24 小时出院，无并发症。最终病理证实为子宫平滑肌瘤。根据我院规定，要求签署书面知情同意书。
成功实施了腹腔镜切除右侧阔韧带和闭孔窝症状性寄生性平滑肌瘤。强调了了解盆腔解剖结构对于处理此类病例的重要性。
