Parasitic Myomas: Surgical Management and a Novel Approach to Prevention

INTRODUCTION: Parasitic myomas, or those that reside outside the uterus and receive primarily extrauterine blood supply, were first described in 1997. While there are multiple theories of pathogenesis, there is a high correlation of identified cases with laparoscopic myomectomy, supporting the theory of fibroid fragment seeding. The incidence of parasitic fibroids is estimated to be between 0.12% and 1.2%. However, many cases are asymptomatic, raising the possibility of a higher true incidence. OBJECTIVE: The objectives of this video are to review background information on parasitic myomas, to demonstrate their management, and to show a containment system for power morcellation. METHODS: Educational video highlighting surgical techniques in cases of parasitic fibroids. RESULTS: We present cases that demonstrate risk factors for parasitic fibroid development and their varied presentation. These cases also show the range of locations parasitic fibroids develop, their large quantities, and varied size. We further present a system for using power morcellation contained in a specimen bag. This method aims to reduce the risk of fibroid fragment seeding while allowing for the use of power morcellation. CONCLUSIONS: We have described parasitic myomas and shown their management in three unique cases. Furthermore, we have proposed a novel preventative technique utilizing a containment system for power morcellation that makes specimen extraction easier and eliminates the need for minilaparotomy.