A novel modification of conventional laparoscopic myomectomy using manual assistance for multiple uterine myomas.

OBJECTIVE

To evaluate the efficacy and feasibility of finger-assisted laparoscopic myomectomy for multiple myomas.

METHODS

A total of 565 patients with symptomatic myomas underwent finger-assisted laparoscopic myomectomy between January 2006 and March 2011 to remove multiple myomas at our center. Laparoscopic myomectomy technique was modified, and involved the insertion of two fingers into the vagina to elevate the uterus, while one or two fingers of the other hand were inserted into the abdomen through a suprapubic 15-mm trocar port for palpation of small myomas, which did not distort the uterine contour.

RESULTS

The mean (SD; range) patient age was 38.26 years (5.84; 25-48 years). The diameter of the largest myoma in each case was 6.13 cm (1.21; 4-15 cm). The total number of myomas enucleated in the initial enucleation was 2228. There were 597 additional myomas enucleated with finger-assisted guidance. The mean diameter of the additionally enucleated myomas was 1.1 cm (range, 0.2-2.5 cm), which was significantly smaller than those of the initially enucleated myomas (p=0.002). The mean operative time was 97.1 min (30.2; 35-180 min). The decrease in postoperative hemoglobin concentration was 1.6g/dL (0.7; 0.4-3.2g/dL). During the operation, no patients required a blood transfusion. Six patients developed postoperative fever. There was no occurrence of bowel or urinary tract injury. The mean postoperative hospital stay was 3.2 days (0.9; 2-6 d). All procedures were successfully completed without the need for laparotomy.

CONCLUSIONS

Finger-assisted laparoscopic myomectomy is a feasible and safe approach in the surgical treatment of multiple myomas.