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The excision of uterine fibroids by vaginal myomectomy: a prospective study
1Endoscopy Training Centre, University Department of Obstetrics and Gynaecology, Royal Free Hospital, Hampstead, London, United Kingdom.
Objective:
To evaluate the clinical effectiveness and safety of the excision of uterine fibroids by vaginal myomectomy.
Design:
Prospective study.
Setting:
A gynecology department of a university teaching hospital.
Patient(S):
Women with menorrhagia, pelvic pain, symptoms of pressure, or subfertility attributable to moderate-sized uterine fibroids who otherwise would have required abdominal or laparoscopic myomectomy.
Intervention(S):
Vaginal myomectomy.
Main Outcome Measure(S):
The feasibility of vaginal surgery, operative complications, postoperative recovery, and relief of symptoms.
Result(S):
Myomectomy was completed vaginally in 32 (91.4%) of 35 patients and none required hysterectomy. The overall operating time was 78 minutes, the estimated operative blood loss was 313 mL, and the mean postoperative hospital stay was 4 days. Pelvic hematomas developed in 4 patients, and one colpotomy required resuture. Seventy-four percent of the women reported relief of their symptoms at 3 months' follow-up. Three patients have had full-term pregnancies since the operation.
Conclusion(S):
Myomectomy can be performed by the vaginal route in selected cases with low morbidity and a good short-term success rate. Unlike open myomectomy, it requires no skin incision, and unlike laparoscopic myomectomy, it can be used in patients who have numerous, relatively large, and intramural fibroids.
