Transvaginal contained tissue extraction after laparoscopic myomectomy: a cohort study

ObjectiveTo describe the technique and report perioperative outcomes of transvaginal contained extraction of surgical specimens at laparoscopic myomectomy.DesignRetrospective analysis of prospectively collected data.SettingTwo Italian referral centres for gynaecological minimally invasive surgery.PopulationConsecutive patients who underwent laparoscopic myomectomy.MethodsTissue extraction was accomplished following laparoscopic myomectomy in a specimen retrieval bag via a posterior colpotomy incision. If morcellation was necessary, this was performed extracorporeally, using a scalpel within the specimen retrieval pouch, whose edges were exteriorised through the vaginal introitus.Main outcome measuresIntra- and postoperative complications.ResultsA total of 316 women underwent transvaginal specimen retrieval with enclosed manual morcellation. The mean myomectomy specimen weight was 154128g, and the mean operative time was 7926minutes. No intraoperative complications occurred related to the specimen extraction or morcellation technique, or from rupture of the retrieval bag. Two (0.6%) women had a haemoperitoneum that spontaneously resolved and 16 (5.1%) had fever postoperatively. The final pathological diagnosis was benign in all cases. At the 30-day follow-up, no pelvic infection, vaginal dehiscence, or complaints of dyspareunia were recorded.ConclusionsContained transvaginal extraction of fibroid specimens can be performed safely and efficiently in most women undergoing laparoscopic myomectomy. This technique represents a valuable minimally invasive alternative to intracorporeal morcellation.Tweetable abstractTransvaginal contained morcellation at laparoscopic myomectomy is a valuable alternative to intracorporeal morcellation.Tweetable abstract Transvaginal contained morcellation at laparoscopic myomectomy is a valuable alternative to intracorporeal morcellation.