Endometriosis, Cervical and Broad Ligament Leiomyomas: How to Avoid Injuries



The challenges while operating in cases of endometriosis and cervical and broad ligament leiomyomas are the fact that the lesion can be very close to the ureter. There could be ureteric compression and hydroureter in long-standing cases. In addition, endometriosis is known to involve the bowel. The condition might require uretric reimplantation if the ureters are involved. Resection anastomosis of the involved segment may be required if the disease involves the bowel. The urological component of the surgery has to be done with a urologist, and bowel resection and anastomosis have to be done with a surgeon. The fundamental principles of operating in such cases are use of sharp dissection and locating the ureter early in the course of dissection in order to avoid ureteric injuries. One must try to excise all the endometriotic tissues in order to avoid recurrence. In case of leiomyomas, one must try and avoid morcellation of the specimen if the leiomyoma is very large, soft, and fleshy and appears on gross examination like a sarcoma. Before considering myomectomy for improving fertility, options like IVF and surrogacy must be discussed since successful removal of leiomyomas and conception are two different issues. During myomectomy for improving fertility, the leiomyoma(s) must be removed without incising the uterine cavity or must be removed through a single incision in the uterine cavity. The risks of preterm labor, uterine rupture, placenta previa, and placenta accreta are high if the uterine cavity is opened during myomectomy.


  1. 1.
    Rakotomahenina H, Rajaonarison J, Wong L, Brun JL. Myomectomy: technique and current indications. Minerva Ginecol. 2017;69(4):357–69.PubMedGoogle Scholar
  2. 2.
    Kim HS, et al. Uterine rupture in pregnancies following myomectomy: a multicenter case series. Obstet Gynecol Sci. 2016;59(6):454–62.CrossRefGoogle Scholar
  3. 3.
    Mohling SI, Elkattah R, Furr RS. Endometriosis: tools for the frozen pelvis. J Minim Invasive Gynecol. 2015;22(6):S139.CrossRefGoogle Scholar
  4. 4.
    De La Hera-Lazara, et al. Radical surgery for endometriosis: analysis of quality of life and surgical procedure. Clin Med Insights Women’s Health. 2016;9:7–11.Google Scholar
  5. 5.
    Stegmann BJ, et al. Using location, color, size, and depth to characterize and identify endometriosis lesions in a cohort of 133 women. Fertil Steril. 2008;89(6):1632–6.CrossRefGoogle Scholar
  6. 6.
    Llewellyn-Bennett, et al. Iatrogenic endometriosis of the vaginal vault following a total laparoscopic hysterectomy. West Lond Med J. 2010;2(4):1–4.Google Scholar
  7. 7.
    Engelsgjerd JS, LaGrange CA. Ureteral injury. Treasure Island, FL: StatPearls Publishing; 2018. Last Update: October 27.Google Scholar
  8. 8.
    Burks FN, Santucci RA. Management of iatrogenic ureteral injury. Ther Adv Urol. 2014;6(3):115–24.CrossRefGoogle Scholar
  9. 9.
    El-Khalfaoui K, Bois A, Heitz, Kurzeder C, Sehouli J, Harter P. Current and future options in the management and treatment of uterine sarcoma. Ther Adv Med Oncol. 2014;6(1):21–8.CrossRefGoogle Scholar
  10. 10.
    Liu H, Zhu Y, Zhang G, Wang C, Li C, Shi Y. Laparoscopic surgery on broken points for uterine sarcoma in the early stage decrease prognosis. Sci Rep. 2016;6:31229.CrossRefGoogle Scholar
  11. 11.
    Trimble CL, et al. Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia: a gynecologic oncology group study. Cancer. 2006;106:812–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  1. 1.Consultant Gynaec-OncologistMahavir Cancer SansthanPatnaIndia
  2. 2.Department of Obstetrics and GynecologyRamaiah Medical CollegeBangaloreIndia

Personalised recommendations