Objective: To evaluate the feasibility and safety of vaginal anterior and posterior myomectomy (A surgical technique is described.).
Design: Longitudinal prospective study.
Setting: A gynecology department of a university teaching hospital.
Population: Women with surgical indication for myomectomy for pelvic pain, menorrhagia, symptoms of pressure, or subfertility caused by uterine myomas.
Methods: From December 1998 to April 2005, all women with uterine myomas selected for surgical treatment were enrolled in a prospective study and underwent vaginal myomectomy.
Main outcome measures: Feasibility of vaginal myomectomy, surgical data and morbidity, and relief of symptoms.
Results: From 1998 to 2004, 54 patients underwent vaginal myomectomy. There were no cases of laparotomic conversion and hysterectomy. The average operation time was 80 minutes (range, 30 to 170 min). Average blood loss was 80 mL (range, 20 to 350 mL). No complications occurred. The average postoperative stay was 2 days (range, 1 to 3 days). Symptoms resolved in all 54 patients (100%) at 6 months follow-up, and 6 patients had a pregnancy.
Conclusion: Vaginal myomectomy, in well-selected cases, is feasible and well tolerated. Thanks to the "morcellation" technique, vaginal myomectomy can be useful even in case of large, numerous, and intramural fibroids and allows optimal uterine wall reconstruction with minimal tissue trauma. The procedure is also low time-consuming.