2544 Minilaparoscopic Assisted Vaginal Myomectomy: A Novel Technique, Preliminary Study

Abstract

Study Objective The aim of our study is to perfect technique of vaginal myomectomy and evaluate the safety and efficacy of combined minilaparoscopic and vaginal approach through anterior and posterior cul-de-sac. Design Prospective study. Setting Department of Gynecology, City Hospital. Patients or Participants All women with reproductive plans and symptomatic subserous or intramural fibroids from 4 cm to 7 cm in diameter treated with minilaparoscopic assisted vaginal myomectomy (MiniLAVM) in our department were prospectively followed. Interventions Minilaparoscopic assisted vaginal myomectomy. Measurements and Main Results 19 patients entered the study between January 2016 and December 2018. 17 patients had MiniLAVM through the posterior cul-de-sac and 2 through the anterior one. Age range 31–47 years, mean 42.4 ±5.8 years; parity range 0–4, mean 2.1 ± 1.6). Two patients had a prior history of Cesarean sections, 2 patients had undergone pelvic surgery. The mean duration of hospital stay was 3.2±1.5 days (range, 2–4 days). Mean amount of blood loss was 125±87.2мл (range, 20–550 ml). Mean duration of surgery was 106.49±38.2 мин (range, 60–140 minutes). Mean total myoma size was 7.1 ± 1.4 cm (range, 4. 5–7 cm). The mean number of myomata removed was 1.4 ± 1.1. None of the cases were converted to laparotomy. All uterine and colpotomic defects were repaired vaginally. None of the cases required a blood transfusion. No major complications occurred. Two patients had full term labor, one of them underwent a Cesarean section. Conclusion The MiniLAVM procedure offers advantages over both laparoscopic and abdominal myomectomy such as digital palpation, direct suturing, no morcelation needed, good visualisation for evaluation of abdominal organs and appropriate control for place of surgery, the application of an antiadhesive barrier, minimallyinvasiveness with good cosmetic effect. This is a preliminary study involving a small number of patients; we believe a larger study will be required to further investigate the efficiency and safety of MiniLAVM.