Compliance and complications of culdotomy.

BACKGROUND: Culdotomy is a practically exclusive appanage of gynaecological surgeons. Today the transvaginal access to pelvis and abdominal cavity is also utilized for non-gynecological surgery. METHODS: The authors report the complications and compliance of 326 culdotomies performed in the Simple Maternity Unit of Asiago Hospital (Asiago, Vicenza, Italy). The casuistry includes 18 adnexetomies, 90 ovarian cysts and fibroids enucleations and/or resections, 23 paraovarian cysts removals, 59 myomectomies, 120 sterilizations, 11 salpingectomies, 1 adesiolysis, 2 ovarian biopsies and 1 abscess drainage. RESULTS: Couldtomy showed to be a procedure with good results in terms of 18 grade 1 and 1 grade IV (5.8%) of Clavien-Dindo grading system for classification of surgical complications, the incidence of conversions in laparotomies, laparoscopies and vaginal hysterectomy (3.1%), the average hospital postoperatory admission (25 hours), low cost of culdotomy compared to laparotomic and laparoscopic surgery; absence of dispareunia and/or other discomforts at long term. CONCLUSIONS: Culdotomy is a simple, proper and alternative route, especially when morcellation is unavoidable.

Vaginal myomectomy is a safe and feasible procedure: a retrospective study of 46 cases.

AIM: The aim of this study was to establish the feasibility and safety of vaginal myomectomy via posterior colpotomy in a series of consecutive procedures performed by one surgeon. MATERIAL AND METHODS: We conducted a retrospective study in a tertiary care university hospital, involving 46 patients with symptomatic myomas and uteruses smaller than 16 gestational weeks and with no signs of pelvic disease. After a presurgical study, the patients underwent vaginal myomectomy. Characteristics of patients, position and size of myomas, operative data, intraoperative and postoperative complications, and length of hospital stay were recorded. RESULTS: Forty-four women underwent vaginal myomectomy and conversion to laparotomy was required in two cases (4.3%). Two patients suffered from infertility and one of these achieved pregnancy after the procedure. The median size of myomas was 50 mm (range 16-81). In two cases a culdoscopy was performed with a flexible fiberoptic gastroscope to better evaluate size and localization of myomas. Thirty-two patients underwent vaginal myomectomy under general anesthesia and 12 under locoregional anesthesia. The median vaginal operating time was 70 min (range 30-120). The estimated hemoglobin loss was 0.70 g/dL (range 0.40-3.35 g/dL). No severe intraoperative complications occurred. The median duration of hospital stay was 1 day (range 1-6). CONCLUSIONS: Vaginal myomectomy is a safe and feasible surgical procedure if performed by a well-trained, experienced surgeon.