Vaginal morcellation through the posterior cul-de-sac using an electromechanical morcellator after laparoscopic myomectomy or subtotal hysterectomy: a retrospective, case-control study.

Abstract

This study aimed to evaluate the feasibility and safety of vaginal morcellation (VM) through the posterior cul-de-sac (PCDS) using an electromechanical morcellator and to compare the perioperative outcomes of VM with those of abdominal morcellation (AM) to remove a single myoma. The characteristics of 245 consecutive patients who had undergone VM after laparoscopic myomectomy or subtotal hysterectomy were summarized. A retrospective, matched, case-control study was performed; 64 patients had a myoma weighting 100g or more. Cases were matched with controls (ratio 1:2), who had undergone AM, by age, body mass index, specimen weight, surgical type, and surgeon. Body image questionnaires were used to assess the cosmetic outcome. Medians were analyzed using the Mann-Whitney U test. Differences between means were assessed using Student's t test. Dichotomous groupings were analyzed using either the Chi-squared test or Fisher's exact test, as appropriate. All 245 patients underwent VM without complications. The mean weight of the specimens was 197.2g (range 78.5-1477g), and the mean duration of morcellation was 13.0min (range 2.0-45.0min). Two hours after surgery, the visual analog scale (VAS) score was significantly lower in the VM group than in the AM group (P=0.03). Moreover, the morcellator used was significantly larger in the VM group (P<0.001), and morcellation duration was significantly shorter in the VM group (P<0.001). Finally, cosmetic outcome was significantly better in the VM group (P<0.02). The two groups did not differ significantly in terms of hospitalization duration, surgery duration or VAS score 24 and 47h postoperatively. VM through the PCDS using an electromechanical morcellator is a safe and feasible technique for surgical excision. The benefits of the procedure over AM are reduced immediate postoperative pain, shorter morcellation time, and better cosmesis.