title: Comparison of morcellator and culdotomy for extraction of uterine fibroids laparoscopically.
abstract: OBJECTIVE
  To define a rational guideline for the removal of uterine fibroids after laparoscopic myomectomy (LM) by culdotomy or morcellator in multiparae.
  
  
  METHODS
  A total of 416 multiparae receiving LM were retrospectively studied between November 1997 and January 2014. Of these, 335 had fibroids removed by culdotomy and 81 by a laparoscopic 15mm electromechanical morcellator. Data on parity, number, size and weight of fibroids, operating time, specimen removal time, blood loss, postoperative stay, hospital charges and complications were recorded. The patients were analyzed in four subgroups stratified by main fibroid size and type of procedure.
  
  
  RESULTS
  There was no significant difference in body mass index, number of fibroids removed, blood loss, complications, and hospitalization duration between the groups. For fibroids below 10cm, the morcellator was significantly faster compared to culdotomy (10min versus 12min, p<0.001). For fibroids 10cm and above, there was no significant difference in time by culdotomy compared to morcellator (24min versus 20min, p=0.497). The electromechanical morcellator was significantly more expensive.
  
  
  CONCLUSIONS
  Fibroid size of 10cm may be used as a guide for the route of fibroid removal; below 10cm the morcellator is faster but more expensive, for fibroids 10cm and above, culdotomy can be considered as it has a similar removal time to the morcellator in multiparae.
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan. Electronic address: wang2260@gmail.com.
authors.forename: Chin-Jung
authors.initials: CJ
authors.lastname: Wang
authors.affiliation: Department of Obstetrics and Gynecology, Minimally Invasive Surgery Unit, KK Women's and Children's Hospital, Singapore.
authors.forename: Jiah Min
authors.initials: JM
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan.
authors.forename: Hsing-Tse
authors.initials: HT
authors.lastname: Yu
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan.
authors.forename: Chen-Ying
authors.initials: CY
authors.lastname: Huang
authors.affiliation: Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan.
authors.forename: Hung-Yen
authors.initials: HY
authors.lastname: Chin
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan.
authors.forename: Shih-Ming
authors.initials: SM
authors.lastname: Wang
mesh_terms: D000328:Adult; D020884:Colpotomy; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D007889:Leiomyoma / Q000601:surgery*; D016014:Linear Models; D008875:Middle Aged; D010298:Parity; D012189:Retrospective Studies; D016896:Treatment Outcome; D063186:Uterine Myomectomy / Q000295:instrumentation / Q000379:methods*; D014594:Uterine Neoplasms / Q000601:surgery*
keywords: Culdotomy; Laparoscopy; Morcellator; Multipara; Myomectomy