Comparison of Laparoscopic Enclosed Electromechanical Morcellation and
Vaginal Enclosed Scalpel Morcellation at Laparoscopic Myomectomy: A
Prospective Randomized Trial
Abstract
Objective: To compare the laparoscopic enclosed electromechanical
morcellation (LEM) with vaginal enclosed scalpel morcellation (VSM) in
laparoscopic myomectomy procedures. Design: Prospective randomized
interventional clinical study. Setting: Tertiary university hospital.
Population or Sample: One hundred eighteen patients who underwent
laparoscopic myomectomy. Methods: All myomectomy procedures were
performed laparoscopically. After myomectomy, tissue removal was
accomplished via either LEM using the previously described in-glove
morcellation technique or VSM. In the VSM group, myoma was placed into
an endoscopic bag and removed through the vagina via posterior colpotomy
after scalpel morcellation. Main Outcome Measures: Primary outcome:
tissue removal time. Secondary outcome: rescue analgesia requirement,
postoperative Visual Analog Scale (VAS) scores, postoperative 3th month
scores of Female Sexual Function Index (FSFI). Results: The median
tissue removal time was longer in the LEM group (25 min (Range: 14-55))
than the VSM group (20 min (Range: 6-38) (p=.001). Rescue analgesia
requirement was significantly higher in the LEM group than the VSM group
(mean rank: 56.92 vs 40.92 doses, respectively; p<.001). There
was no significant difference between the groups at postoperative VAS
scores. There was no significant difference between preoperative and
postoperative 3th month total scores of FSFI and subdomains in the LEM
group. Conversely, all subdomains and total scores of FSFI (26.5
(16.7-34.8) vs. 22.7 (15.2-28.7) except pain significantly worsened
three months after operation in the VSM group. Conclusion: LEM was
associated with a longer tissue removal time and increased postoperative
analgesic requirement. On the other hand, VSM was associated with
worsened postoperative sexual function from baseline.