title: Comparison between bisection/morcellation and myometrial coring for reducing large uteri during vaginal hysterectomy or laparoscopically assisted vaginal hysterectomy: results of a randomized prospective study.
abstract: BACKGROUND
  Vaginal hysterectomy (VH) is being performed increasingly by gynecologic surgeons. Thus, enlarged uteri are more frequently removed vaginally, requiring reducing techniques to allow vaginal extraction.
  
  
  METHODS
  We designed a randomized prospective study to compare bisection-morcellation and myometrial coring. Patients scheduled for VH or laparoscopically assisted vaginal hysterectomy (LAVH) were offered entry into the study. Endometrial cancer was an exclusion criterion. Uterine size was not a contraindication for vaginal surgery. We compared data from preoperative workup as well as from the operative and the postoperative course. Data were recorded prospectively. Results were analyzed with nonparametric tests and logistic regression models.
  
  
  RESULTS
  Thirty patients were included in the study. Patients were similar in both groups. No severe peroperative complication occurred in this series. Operating time was comparable in both groups. Uteri weighed more than 280 g in more than 70% of patients in both groups. Myometrial coring failed more often than bisection-morcellation (25% vs. 0%, p = 0.06). Patients and uteri characteristics had no influence on the risk of failure, except for narrow uteri, which were associated with an increased risk of failure in the myometrial coring group only (68.3 vs. 83.9 mm, p = 0.01). Postoperative courses were similar for the two techniques, except for an increased rate of fever in the myometrial coring group (28%, p = 0.03).
  
  
  CONCLUSIONS
  Both techniques appeared safe in this trial. Myometrial coring failed more frequently than bisection-morcellation, especially in the case of a narrow uterus. Postoperative fever was significantly more common after myometrial coring. Both techniques should be taught to resident surgeons.
authors: Service de Chirurgie Gynécologique et Cancérologique, Hôpital Européen Georges Pompidou, Paris, France.
authors: Intissar
authors: I
authors: Nazah
authors: François
authors: F
authors: Robin
authors: Jean Philippe
authors: JP
authors: Jais
authors: Louis
authors: L
authors: Jeffry
authors: Loic
authors: L
authors: Lelievre
authors: Sophie
authors: S
authors: Camatte
authors: Roland
authors: R
authors: Taurelle
authors: Fabrice
authors: F
authors: Lecuru
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods*; D010535:Laparoscopy; D016015:Logistic Models; D008875:Middle Aged; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014599:Uterus / Q000473:pathology*