Broad ligament fibroids-a radiological and surgical challenge

Currently, there is limited data on the ease of imaging of broad ligament fibroids and their safe laparoscopic management. We aimed to review all laparoscopic myomectomies over an 8-year period, focusing on intraoperative findings and corresponding pre-operative imaging. All laparoscopic myomectomies performed between 2004 and 2012 were reviewed. Cases with broad ligament fibroids were identified. Presenting symptoms, imaging, intraoperative findings, complications and 6-month follow-up were noted. Ten broad ligament fibroids were identified from 185 cases of laparoscopic myomectomies. Mean broad ligament fibroid diameter was 8.1 cm, and the largest was 15 cm. Mean combined fibroid weight was 267 g (range 30-560 g). Blood loss was associated with the total number of fibroids excised rather than the diameter of the broad ligament fibroid (range 30-400 ml). Accurate pre-operative diagnosis at imaging was made in only one of the ten broad ligament fibroids. Of the remainder, one was thought to be an ovarian mass, one fibroid was missed entirely and seven were reported non-specifically as 'lateral'. This case series indicates the challenge posed by broad ligament fibroids at pre-operative imaging. Underreporting may reflect a lack of awareness of the surgical significance of broad ligament fibroids. There should be a high level of suspicion for location within the broad ligament if a fibroid reported is as lateral. With adequate operator experience, large fibroid size should not contraindicate laparoscopic management of broad ligament fibroids.