[Vaginal or laparoscopic assisted vaginal myomectomy: interest in the double way].
OBJECTIVE
To evaluate vaginal and laparoscopic-assisted vaginal myomectomy in order to find interest and indications of this two-way approach of myomectomy.


METHODS
Retrospective study of 60 patients operated of a myomectomy by vaginal or laparoscopic-assisted vaginal way between December 1999 and January 2007.


RESULTS
Thirty-three patients (55%) profited from an exclusive vaginal myomectomy (group 1) and 27 (45%) from a laparoscopic-assisted vaginal myomectomy (group 2). The vaginal gesture in group 2 was carried out mainly because of difficult dissections of deep interstitial myomes (60%) or for the closing of hysterotomies not accessible by coelioscopic way (40%). Mean operating time, blood loss and length of hospital stay were 120 minutes, 431 ml, 3.2 days in group 1 and 180 minutes, 437 ml, 5.1 days in group 2, respectively. Laparoconversions and notable complications rates were 9% in group 1 and 15% in group 2.


CONCLUSIONS
Laparoscopic-assisted vaginal myomectomy is interesting to widen indications of laparoscopic way for myomectomy. However, considering complications and rate of laparoconversion, it is necessary to define situations against indicating this gesture. The methods of prevention of the infection also remain to be found.
Carbonnel
M
M
Service de gynécologie-obstétrique, hôpital Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.
Le Tohic
A
A
Yazbeck
C
C
Madelenat
P
P
D000328:Adult; D020884:Colpotomy / Q000379:methods*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D015907:Hysteroscopy / Q000379:methods; D010535:Laparoscopy / Q000379:methods*; D007889:Leiomyoma / Q000601:surgery*; D007902:Length of Stay; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000601:surgery*; D014621:Vagina / Q000601:surgery