Feasibility and safety of vaginal myomectomy: a prospective pilot study

Abstract

Study objective: Classic myomectomy was performed via laparotomy. More recently, laparoscopic myomectomy has become a valuable treatment option. Vaginal myomectomy is a surgical procedure that has recently been evaluated. However, few trials have been reported in past literature. The aim of this study was to evaluate feasibility and complication rate of patients submitted to vaginal myomectomy.

Design: Prospective study with review of literature (Canadian Task Force classification II-2).

Setting: Department of Obstetrics and Gynecology, S. Filippo Neri Hospital of Rome, Italy.

Patients: Consecutive patients with symptomatic myomas who refused hysterectomy.

Interventions: After preoperative assessment, patients were submitted to vaginal myomectomy using posterior colpotomy.

Measurements and main results: Operative time, perioperative complications, and hospital stay were prospectively recorded. Follow-up examinations were performed at 1 and 12 months postoperatively. Data on possible symptoms, fertility, and pregnancy outcome during follow-up periods were recorded. Myomectomy was completed vaginally in 17 (94%) of 18 patients. Mean operating time was 48 +/- 22 minutes; mean operative blood loss and hospital stay were 210 +/- 350 mL and 3.5 +/- 2.4 days, respectively. Only 2 (11%) patients required blood transfusion. Three patients have conceived spontaneously.

Conclusion: Vaginal myomectomy is a feasible and safe surgical procedure, with low morbidity and short hospital stay, and could represent a valid alternative to open or laparoscopic myomectomy in selected cases.