Back to Journals » International Journal of Women's Health » Volume 12

Laparoscopic Myomectomy – Converting to Laparotomy for a Suspicious Intraoperative Appearance with Subsequent Benign Histology – a Pre- and Intra-Operative Dilemma

Authors Wali S, Porter-Hope C, Amin TN, Miskry T

Received 23 April 2020

Accepted for publication 4 August 2020

Published 17 September 2020 Volume 2020:12 Pages 739—744

DOI https://doi.org/10.2147/IJWH.S257136

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Professor Elie Al-Chaer


Sarah Wali,1 Charlotte Porter-Hope,2 Tejal N Amin,1 Tariq Miskry1

1Department of Obstetrics and Gynaecology, St Mary’s Hospital, Paddington, London, W2 1NY, UK; 2Imperial College Medical School, London, UK

Correspondence: Sarah Wali Email Sarah.wali@doctors.org.uk

Background: Although the most common uterine tumour is leiomyoma, the differential diagnoses also include the rarer adenomyoma and leiomyosarcoma. A lack of clear reliable clinical and radiological features makes the triage of uterine masses to the appropriate surgical procedure difficult. In the case of suspicious appearance of a presumed leiomyoma, an open surgical approach is recommended and morcellation is avoided.
Case: We present a case of a woman undergoing an elective laparoscopic myomectomy for a fibroid that appeared benign on ultrasound but had suspicious features intraoperatively. The operation was converted to a laparotomy to avoid the risk of morcellation-related seeding in the event that the histology was malignant. The histology was subsequently a benign exophytic adenomyoma.
Conclusion: The assessment of the nature of fibroids can be difficult both pre- and intraoperatively, and the need for difficult decision making to convert to open surgery during a laparoscopic myomectomy but with subsequent benign histology should be part of patient counselling.

Keywords: adenomyoma, communication, differential diagnosis, converting to laparotomy, morcellation risks, histology

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]