Outcomes of in-bag transvaginal extraction in a series of 692 laparoscopic myomectomies: results from a large retrospective analysis

Study objectiveTransvaginal extraction is feasible method to remove surgical specimen. In this study, we aim to report our experience with in-bag transvaginal specimen retrieval after laparoscopic myomectomy over the last 15 years.DesignSingle-center retrospective analysis.SettingAcademic hospital.PatientsWomen who underwent laparoscopic myomectomy from January 2005 to April 2021.InterventionPosterior colpotomy and in-bag transvaginal extraction of the surgical specimen.Measurements and main resultsWe collected and analyzed data about patients' characteristics, main indication for surgery, intra- and post-operative (within 30 days) complications.ResultsA total of 692 women underwent transvaginal specimen retrieval after laparoscopic myomectomy (mean largest myoma diameter: 6.64 ± 2.21 cm; mean specimen weight: 177 ± 140 grams; mean operative time: 84.1 ± 37.1 minutes; mean blood loss: 195 ± 191 ml). Within 30-days, we reported the following colpotomy-related complications: 4 (0.6%) cases of vaginal bleeding, which resolved spontaneously in 3 cases (one case required readmission with new colporrhaphy under general anesthesia); 2 (0.3%) cases of vaginal pain, with no underlying cause identified on physical examination and pelvic ultrasound. Specimen weight was positively correlated with longer operative time, intraoperative blood loss and length of hospital stay.ConclusionPosterior colpotomy and in-bag transvaginal extraction can be considered a feasible option for retrieval of surgical specimens after laparoscopic myomectomy.