title: Parasitic myoma after laparoscopic morcellation: a systematic review of the literature.
abstract: BACKGROUND
  Laparoscopic morcellation is frequently used for tissue removal after laparoscopic hysterectomy or myomectomy and may result in parasitic myomas, due to seeding of remained tissue fragments in the abdominal cavity. However, little is known about the incidence and risk factors of this phenomenon.
  
  
  OBJECTIVE
  To identify the incidence and risk factors for the development of parasitic myoma after laparoscopic morcellation.
  
  
  METHODS
  A systematic review of the literature in Pubmed (MEDLINE) and Embase was conducted. Reference lists of identified relevant articles were checked for missing case reports.
  
  
  METHODS
  Studies reporting on incidence or cases of parasitic myoma diagnosed after laparoscopic morcellation were selected. Studies were excluded when history of laparoscopic morcellation was lacking or final pathology demonstrated a malignancy or endometriosis.
  
  
  METHODS
  Data were extracted and analysed on incidence of parasitic myomas and characteristics of case reports.
  
  
  RESULTS
  Fourty-four studies were included. Sixty-nine women diagnosed with parasitic myomas after laparoscopic morcellation were identified. Mean age was 40.8 (± 7.5) years (range 24-57), median time between surgery and diagnosis was 48.0 months (range 1-192) and mean number of parasitic myomas was 2.9 (± 3.3) (range 1-16). The overall incidence of parasitic myomas after laparoscopic morcellation was 0.12-0.95%.
  
  
  CONCLUSIONS
  Although the incidence is relatively low, it is important to discuss the risk of parasitic myoma after laparoscopic morcellation with women and balance towards alternative treatment options. The duration of steroid exposure after laparoscopic morcellation might be a risk factor for development of parasitic myomas.
  
  
  CONCLUSIONS
  Systematic review on the incidence and risk factors for parasitic myoma after laparoscopic morcellation.
authors.affiliation: Department of Obstetrics and Gynaecology, Màxima Medical Centre, Veldhoven, the Netherlands.
authors.forename: J F
authors.initials: JF
authors.lastname: Van der Meulen
authors.affiliation: Department of Obstetrics and Gynaecology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.
authors.forename: J M A
authors.initials: JM
authors.lastname: Pijnenborg
authors.affiliation: Department of Obstetrics and Gynaecology, Bravis hospital, Bergen op Zoom & Roosendaal, the Netherlands.
authors.forename: C M
authors.initials: CM
authors.lastname: Boomsma
authors.affiliation: Department of Obstetrics and Gynaecology, Medisch Spectrum Twente, Enschede, the Netherlands.
authors.forename: M F G
authors.initials: MF
authors.lastname: Verberg
authors.affiliation: Department of Obstetrics and Gynaecology, Màxima Medical Centre, Veldhoven, the Netherlands.
authors.forename: P M A J
authors.initials: PM
authors.lastname: Geomini
authors.affiliation: Department of Obstetrics and Gynaecology, Màxima Medical Centre, Veldhoven, the Netherlands.
authors.forename: M Y
authors.initials: MY
authors.lastname: Bongers
mesh_terms: D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D007049:Iatrogenic Disease; D010535:Laparoscopy / Q000009:adverse effects*; D007889:Leiomyoma / Q000473:pathology* / Q000601:surgery; D000069577:Morcellation / Q000009:adverse effects*; D009366:Neoplasm Seeding; D012307:Risk Factors; D063186:Uterine Myomectomy / Q000009:adverse effects*; D014594:Uterine Neoplasms / Q000556:secondary* / Q000601:surgery
keywords: Laparoscopic morcellation; parasitic myoma; systematic review