Culdotomy in laparoscopic myomectomy and its limits

To examine the results and limits of culdotomy method for removal of myoma from the abdomen while preserving its integrity in laparoscopic myomectomy. To determine if this is a good option for tissue extraction.

Retrospective analysis of data collected prospectively.

A gynecology and obstetrics training and research hospital.

A total of 102 patients who underwent laparoscopic myomectomy with culdotomy for tissue extraction.

A total of 102 patients underwent laparoscopic myomectomy between September 2017 and April 2019, and tissues were taken from the abdomen by culdotomy. The mean myoma diameter was 7.7 ± 2.4 cm (4-15 cm) and the mean weight was 161 ± 120 g (20-602 g). The mean duration of surgery was 95 ± 41 min (36-214 min). All myomas were extracted with preservation of their integrity, except in 2 patients. In 87 patients, the myoma was less than 10 cm, and all myomas in this group could be easily extracted from the vagina. The myoma was between 11 and 13 cm in 13 patients. Of these, 8 were extracted without difficulty, 5 could barely be extracted, and superficial vaginal lacerations occurred in 4 of these patients. Due to the inability to extract myomas intact in 2 patients (14 and 15 cm), vaginal mechanical morcellation was performed. In terms of vaginal births, 34 patients (33.3 %) had never had vaginal births, and 68 patients (66.7 %) had a history of vaginal birth. The largest myoma extracted from a woman who had not given birth was 12 cm (345 g). The largest myoma extracted from a woman who had given birth was 13 cm (490 g). None had major complications. No signs of infection were detected on the 7th and 30th postoperative days, and no operative dyspareunia was detected at 6-month follow-up.

In the present study, it was seen that myomas up to 13 cm (490 g) in multiparous and 12 cm (350 g) in nulliparous could be removed from the culdotomy while maintaining their integrity. Culdotomy is a safe, inexpensive and effective method for myoma extraction.