Comparison of transvaginal or transumbilical tissue extraction at laparoscopic gynecologic surgery: A 12-year experience

Abstract

Objective: To present our surgical outcomes by comparing the transumbilical and transvaginal methods for the removal of specimens in laparoscopic surgery of fibroids and adnexal masses during our 12 years of experience. Methods: A retrospective cohort study was conducted at our referral center between January 2012 and April 2024. We evaluated surgical outcomes, patients' clinical-demographic characteristics, cosmetic-pain scores and dyspareunia by comparing the two methods that we use routinely. Results: We retrospectively reviewed 285 patients. Visual analog scale (VAS) scores at 24 h were lower in the transvaginal group than in the transumbilical group (0.4 ± 0.6 vs. 0.8 ± 0.8, P < 0.001). The 3-month postoperative cosmetic score (CS) was higher in the transvaginal group than in the transumbilical group (4.5 ± 0.5 vs. 4.1 ± 0.6, P < 0.001). Furthermore, myomectomy and transumbilical were independent risk factors for lower VAS scores 24 h post surgery (myomectomy: odds ratio [OR] 3.42, P = 0.001, transvaginal route: OR 0.41, P = 0.005). Finally, the transumbilical extraction route and extension of the umbilical incision were independent risk factors for lower CS (P = 0.035 and P = 0.028). Conclusion: Removal of the specimen via the transvaginal route in laparoscopic adnexal mass and fibroid surgeries may lead to less pain in the early postoperative period and better cosmetic results without increasing the duration of the operation, the rate of intraoperative complications, and the rate of dyspareunia.