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

• Main Authors: Wali S, Porter-Hope C, Amin TN, Miskry T
• Format: Article
• Language: English
• Published: Dove Medical Press 2020-09-01
• Series: International Journal of Women's Health
• Subjects: adenomyoma; communication; differential diagnosis; converting to laparotomy; morcellation risks; histology
• Online Access: https://www.dovepress.com/laparoscopic-myomectomy-ndash-converting-to-laparotomy-for-a-suspiciou-peer-reviewed-article-IJWH

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, UKCorrespondence: Sarah Wali Email [e-mail]: 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