The excision of uterine fibroids by vaginal myomectomy: a prospective study

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 mt, 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. (C) 1999 by American Society for Reproductive Medicine.