Laparoscopic Resection of a Symptomatic Parasitic Leiomyoma of Paravesical and Obturator Fossa.

Study 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: University hospital.

Interventions: 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.

Conclusion: 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.