Laparoscopic management of uncommon benign uterine tumors: a systematic review

  • Zaki SleimanEmail author
  • Sara Hussein
  • Amani Mohsen
  • Aline Khazzaka
  • Alessandro Tropea
  • Antonio Biondi
Review Article


The objective of the study was to review the reported cases of uncommon benign uterine tumors managed by laparoscopy. Medline database was searched using predefined search terms linked to atypical leiomyomas, leiomyoma variants, laparoscopy and morcellation. Quality of articles was assessed using Joanna Briggs Institute (JBI) critical appraisal tool. Due to heterogeneity in reporting characteristics of the patients, radiological findings, macroscopic findings, histological characteristics and follow-up, we performed a narrative synthesis. We included 109 cases of leiomyoma variants managed by laparoscopy. This stands for an incidence of 2.5% out of all the included laparoscopic management of leiomyomas. These cases were approached as classic leiomyoma. Only after the final histological results that their uncommon aspect was diagnosed. Intra-operatively, the management was similar to that of leiomyoma, with either myomectomy or hysterectomy performed depending on each individual case. Follow-up of these cases was variable: one case (0.9%) recurred as peritoneal sarcoma after 5 years of follow-up. It is important for the gynecologist, radiologist and pathologist to be aware about leiomyoma variants trying to diagnose them preoperatively. Strict follow-up of these cases is mandatory, because of the risk of recurrence and the very low but possible risk of future sarcomas.


Uncommon benign uterine tumors Atypical leiomyomas Laparoscopy Diagnosis Surgical outcomes 



The work was not supported by any fund/grant.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent is not required for this type of study.


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Copyright information

© Italian Society of Surgery (SIC) 2019

Authors and Affiliations

  • Zaki Sleiman
    • 1
    Email author
  • Sara Hussein
    • 2
  • Amani Mohsen
    • 2
  • Aline Khazzaka
    • 2
  • Alessandro Tropea
    • 3
  • Antonio Biondi
    • 4
  1. 1.Department of Obstetrics and GynecologyLebanese American UniversityBeirutLebanon
  2. 2.Laboratory of Science and ResearchSaint Joseph UniversityBeirutLebanon
  3. 3.Department for the Treatment and Study of Abdominal Diseases and Abdominal TransplantationIRCCS-ISMETT (Istituto Mediterraneo Per I Trapianti E Terapie Ad Alta Specializzazione), University of Pittsburgh Medical Center ItalyPalermoItaly
  4. 4.Department of General Surgery and Medical Surgical SpecialtiesUniversity of CataniaCataniaItaly

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