Disseminated leiomyomatosis and endometriosis following laparoscopic supracervical hysterectomy

Objective: To describe cases of disseminated leiomyomatosis and diffuse endometriosis following laparoscopic supracervical hysterectomies. Methods: Using an administrative hospital-based database, all cases of laparoscopic supracervical hysterectomies performed between 1992 and 1998 were identified. Any cases requiring subsequent pelvic surgery (laparoscopic or open technique) were reviewed. Results: A total of 146 laparoscopic hysterectomies were performed in this time period. The indications were symptomatic leiomyomata (83), endometriosis (29), or both (24). Other diagnoses were responsible for the remaining 10 cases. The mean age of the patient at the time of hysterectomy was 41. Seven patients had subsequent surgery: removal of cervical stump for low-grade endometrial stromal sarcoma (final pathology was negative) and recurrent pain (6 cases) (final pathology revealed disseminated leiomyomatosis, endometriosis [2], giant cell reaction, connective tissue, and incidental Brenner tumor). The mean time interval between surgeries was 39 months. Of those 7 cases, 4 were completed laparoscopically. Conclusions: Disseminated leiomyomatosis and diffuse endometriosis may occur following laparoscopic supracervical hysterectomy. Presumably small, even microscopic, fragments of smooth muscle or endometrium dispersed during morcellation can proliferate and ultimately result in pelvic pain and masses.