Laparoscopic Approach to a Large Ovarian Fibroma: A Case Report
A 24 year old Gravida 1 Para1 (G1P1) lady presented to the gynecology clinic of Rasoul-e-Akram hospital with pelvic discomfort for one year, which was recently exacerbated and dominantly located on right lower quadrant of the abdomen. The patient had no medical or surgical history, except for one Pfannenstiel-kerr cesarean section about 3 years ago. Primary physical examinations revealed a mobile solid mass of nearly 12 − 14 cm in diameter, which couldn't be differentiated from a uterine myoma. Pelvic ultrasonography showed a mixed echo mass of 117×83 mm in right adenexa, with vascular flow and pressure on posterior wall of the uterus. There was no sign of ascites or plural effusion. Preoperatively, tumor markers were assessed, which were within normal range and patient was scheduled for laparoscopic resection of the lesion on December 2012 in Rasoul-e-Akram hospital.\nAbdominal access was achieved by primary puncture with a 10 mm diameter umbilical cannula. Two other 5 mm diameter ancillary cannulas were introduced after creation of pneu-moperitoneum by nearly 2.5 L of carbon dioxide.\nA rigid video laparoscope was entered via umbilical port and two grasping forceps were introduced via two ancillary cannulas. During the procedure, the patient was placed in Trende-lenburg position. Several adhesion bundles were seen between uterus, adnexa, omentum and abdominal wall that were lysed. The right ovary contained a huge (10×15 cm), multiloculated, mobile and well circumscribed mass with laparoscopic features similar to a benign ovarian mass especially an ovarian fibroma or thecoma ().\nWe sent a sample for frozen section examination which proved the benign nature of the tumor, ovarian fibroma. Despite the size of the mass and tight adhesion of the capsule to the ovarian tissue, with a careful dissection and desiccation of the tumor, we could preserve the ovary during complete excision of the fibroma. After the excision of the ovarian fibroma, under direct vision of a 5 mm telescope, it was morcellated and removed through the umbilical port.\nPneumoperitoneum was then deflated and ports were removed under direct vision. Finally, the rectus sheath and skin were closed with vicryl 2/0. Operating time from incision to closure was nearly 50 min, with no intraoperative complication. Postsurgical recovery was uneventful and the patient was discharged on the second day of surgery. There were also no immediate postoperative complications. Histopathologic examination revealed proliferation of spindle cells with blended nucleus in stratiform pattern with no pleomorfism or mitotic activity, which confirmed the diagnosis of ovarian fibroma ().