Original ArticleElectric Motorized Morcellator Versus Transvaginal Extraction for Myoma Retrieval After Laparoscopic Myomectomy: A Propensity-matched Analysis
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
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Cited by (34)
Safety of Minimally Invasive Tissue Extraction in Myoma Management: A Systematic Review
2021, Journal of Minimally Invasive GynecologyCitation Excerpt :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).
Culdotomy in laparoscopic myomectomy and its limits
2020, European Journal of Obstetrics and Gynecology and Reproductive BiologyThe impact of morcellation on survival outcomes of undiagnosed uterine sarcoma
2018, Gynecologic Oncology ReportsTransumbilical extraction of 151–300-g myomas without morcellator versus conventional laparoscopic myomectomy with power morcellator
2017, Gynecology and Minimally Invasive TherapyImpact of Morcellation of Occult Malignancies at the Time of Vaginal Hysterectomy
2017, Journal of Minimally Invasive GynecologyMorcellation worsens survival outcomes in patients with undiagnosed uterine leiomyosarcomas: A retrospective MITO group study
2017, Gynecologic OncologyCitation Excerpt :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].
The authors report no conflict of interest.