Laparoscopic-assisted vaginal myomectomy: A feasibility study

Abstract

This pilot study assessed the feasibility and complications of a combined laparoscopic and vaginal approach through the posterior colpotomy in cases of fundal or posterior wall uterine fibroids. Twenty-four women with single symptomatic fibroids (size 5-8 cm) were prospectively assigned to undergo either laparoscopic-assisted vaginal myomectomy (LAVM; n=12) or laparoscopic myomectomy (LM; n=12). Surgical characteristics, hospital stay, and complications were analyzed. Blood samples for assay of tissue markers [C-reactive protein (CRP), creatine kinase (CK), and white blood cell count] and hemoglobin were taken preoperatively and on the 1st and 3rd postoperative days. There were no differences between the two groups with regard to demographic characteristics. The mean operating time was shorter in the LAVM group (64.44±17.4 min vs. 89.00±23.4 min, P<0.05). There was no difference in blood loss or complications between the groups. One woman in the LM group required vaginal conversion for an unsuccessful hemostasis during laparoscopic coagulation. The difference in decline of hemoglobin and tissue marker levels was statistically insignificant. Only the serum CRP level was statistically different between the groups. This may indicate that the local abdominal wall injury in the LM group was influenced by minilaparotomy in two cases of larger fibroids. In both groups, serum CRP was significantly increased when blood loss was greater than 200 ml. In conclusion, LAVM is a feasible minimally invasive procedure and has also been associated with a shorter operating time compared with LM. A combined laparoscopic and vaginal approach in dealing with fundal and/or posterior wall uterine fibroids through the posterior cul-de-sac is an alternative to either pure laparoscopic myomectomy or laparoscopic-assisted myomectomy. © Springer-Verlag Berlin / Heidelberg 2005.