title: Pierce and push: a simplified method to facilitate laparoscopic myomectomy.
abstract: BACKGROUND
  The aim of this study was to present our experience with a novel approach called the pierce and push (PP) method which uses a stainless steel centimeter probe instead of a 5 mm claw forceps to enucleate fibroids in a laparoscopic myomectomy (LM).
  
  
  METHODS
  A retrospective chart review of 90 women with symptomatic uterine fibroids who underwent an LM was performed. Cases of LM with the PP method were compared with a matched control group of LM with a 5 mm claw forceps. The operative time, tumor separation time, specimen removal time, amount of blood loss, requirement for blood transfusion and length of hospital stay were compared between groups.
  
  
  RESULTS
  The two groups were matched by age, body mass index, previous cesarean delivery, main fibroid size, and number and weight of fibroids. The tumor separation time was significantly shorter in the PP group than the claw forceps group (9.7 ± 3.1 minutes versus 17.1 ± 4.4 minutes, p < 0.001). The length of the operation, hospitalization time, specimen removal time, amount of blood loss, and requirement for blood transfusion were not significantly different between groups.
  
  
  CONCLUSIONS
  A stainless steel centimeter probe has an advantage over a 5 mm claw forceps in pushing and pulling fibroids. Our findings indicate that the PP method was much more effective in excision of fibroids than a 5 mm claw grasper in LM.
authors.affiliation: Division of Gynecologic Endoscopy, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Pei-Ju
authors.initials: PJ
authors.lastname: Wu
authors.forename: Kai-Yun
authors.initials: KY
authors.lastname: Wu
authors.forename: Chien-Min
authors.initials: CM
authors.lastname: Han
authors.forename: Hsuan
authors.initials: H
authors.lastname: Su
authors.forename: Chin-Jung
authors.initials: CJ
authors.lastname: Wang
authors.forename: Chyi-Long
authors.initials: CL
authors.lastname: Lee
mesh_terms: D016022:Case-Control Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D007889:Leiomyoma / Q000601:surgery*; D009215:Myometrium / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000601:surgery