Vaginal and laparoscopic myomectomy for large posterior myomas: results of a pilot study

To evaluate the feasibility and complications of vaginal and laparoscopic myomectomy, and analgesic drug consumption.

We conducted a pilot study involving 24 women with single, large (>5cm) symptomatic posterior uterine leiomyomas. Twelve women underwent vaginal myomectomy and 12 laparoscopic myomectomy. The main outcome measures were the operating time, peri- and post-operative complications, and analgesic drug consumption.

There was no difference in mean age, the rate of nulliparity, and the mean size of myomas between the two groups. The mean operating time was shorter in the vaginal group (96+/-38min versus 166+/-78min; P<0.01). There was no difference in mean blood loss or fibroid weight between the two groups. One of the 12 patients in the vaginal myomectomy group required laparoscopic conversion for an inaccessible fundal myoma. Post-operative morphine consumption was lower in the vaginal group (37.2+/-64mg versus 150.8+/-42mg; P<0.003). No post-operative complications occurred in either group. Gas and stool recovery, the length of hospital stay, and the time required to return to normal activity were similar in the two groups.

Vaginal myomectomy is feasible and safe, and was associated with a shorter operating time and lower morphine consumption than laparoscopic myomectomy.