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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


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

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

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