Elsevier

Journal of Minimally Invasive Gynecology

Volume 21, Issue 5, September–October 2014, Pages 928-934
Journal of Minimally Invasive Gynecology

Original Article
Electric Motorized Morcellator Versus Transvaginal Extraction for Myoma Retrieval After Laparoscopic Myomectomy: A Propensity-matched Analysis

https://doi.org/10.1016/j.jmig.2014.04.012Get rights and content

Abstract

Study Objective

To compare surgery-related outcomes of electric motorized morcellator (EMM) and transvaginal extraction (TVE) for myoma retrieval after laparoscopic myomectomy.

Design

A retrospective propensity-matched analysis of prospectively collected data (Canadian Task Force classification II-2).

Setting

A university teaching hospital.

Patients

One hundred women undergoing laparoscopic myomectomy.

Interventions

Laparoscopic myomectomy followed by myoma retrieval via TVE or EMM.

Measurements and Main Results

Fifty propensity-matched patient pairs (100 patients) undergoing laparoscopic myomectomy followed by myoma retrieval via TVE or EMM were studied. No significant differences were observed in baseline patient characteristics. Operative times were similar between groups (66 vs 73 minutes in the TVE and EMM group, respectively, p = .19). However, patients undergoing TVE experienced lower specimen retrieval time than patients undergoing extraction via EMM (5 [3–30] vs 7 [3–35] minutes, p < .001). Blood loss, transfusion, and complication rates were similar between groups. One retrieval-related complication occurred in the EMM group (bleeding from an incision using a morcellator requiring resuture). The need for an analgesic rescue dose was lower in the TVE group compared with patients in the EMM group (p = .03). Although overall satisfaction levels were similar between groups, TVE is related to higher cosmetic outcomes compared with EMM (9.5 [±0.6] vs 8.5 [±1], p < .001).

Conclusion

TVE upholds the effectiveness of EMM, minimizing the operative time and potentially postoperative pain. Further large prospective studies are needed.

Section snippets

Methods

Data of women undergoing laparoscopic myomectomy from January 2004 through December 2013 were searched. During the study period, 169 women underwent laparoscopic myomectomy at the gynecologic department of Azienda Ospedaliera, Ospedale di Circolo Fondazione Macchi, University of Insubria, Varese, Italy. Patients who did not consent to use clinical information for research purposes and patients diagnosed with unexpected uterine cancer were excluded.

The inclusion criteria were as follows: (1) age

Results

Fifty propensity-matched patient pairs (100 patients) undergoing myomectomy plus myoma morcellation with EMM versus TVE represented the study group. Figure 1 shows the flow of patients thorough the study design. No significant differences were observed in baseline patient characteristics between groups after propensity score matching (Table 1). The dominant myoma diameter was 6 (range, 3–12) and 6 (range, 3–14) cm in the TVE and EMM group, respectively (p = .28). Similarly, no differences in

Discussion

The presented study evaluated 2 approaches for myoma retrieval after laparoscopic myomectomy. We investigated outcomes related to the use of EMM and TVE and showed a number of noteworthy findings. First, we observed that TVE is related to a shorter retrieval time in comparison with the use of EMM. Second, TVE avoids the enlargement of an ancillary port, thus improving cosmetic outcomes and potentially reducing postoperative pain. Third, overall, we reported favorable outcomes and a high

Conclusion

In conclusion, the present study evaluated myoma retrieval via EMM and TVE, thus providing further background to embrace TVE for myoma retrieval after laparoscopic myomectomy. We observed that TVE is a safe, feasible, and effective method for myoma retrieval. TVE reduces the operative time and improves postoperative outcomes in comparison with the use of EMM. However, because of the nonrandomized nature of the present investigation, the execution of randomized studies comparing EMM and TVE is

References (37)

Cited by (34)

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    Rechberger et al [61]reported 1 morcellator-related small bowel injury in a study of 426 women undergoing uncontained abdominal power morcellation. In the study by Bogani et al [147], comparing 100 women undergoing uncontained abdominal power morcellation vs contained vaginal manual morcellation at the time of myomectomy, they reported a patient with postoperative day 1 bleeding from the trocar site used for morcellation that required suturing at the bedside. A total of 3208 patients were included in 32 studies that reported on the outcome of morcellation time (Table 6).

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  • Morcellation worsens survival outcomes in patients with undiagnosed uterine leiomyosarcomas: A retrospective MITO group study

    2017, Gynecologic Oncology
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    uterine sarcomas represent a low prevalence condition with no pathognomonic diagnostic features. To try to combine these two opposite situations the crucial point is to increase accuracy of diagnostic tool and to implement research on strategies to avoid intra-abdominal morcellation, including in-bag morcellation, or suitable alternatives such as the retrieval of specimen via a mini-laparotomic incision or by the transvaginal extraction of masses through posterior colpotomy [27,28]. In the diagnostic field, an interesting proposal is the development of a scoring system using multiple predictors for the preoperative diagnosis of uterine sarcomas: the PREoperative Sarcoma Score (PRESS) [29] including age, serum lactate dehydrogenase (LDH) levels, endometrial cytological findings and MRI findings reported diagnostic accuracy, positive predictive value, negative predictive value, sensitivity and specificity of 84%, 63%, 93% 80% and 85%, respectively [30].

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The authors report no conflict of interest.

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