Outcomes of In-bag Transvaginal Extraction in a Series of 692 Laparoscopic Myomectomies: Results from a Large Retrospective Analysis

Study Objective: Transvaginal extraction is a feasible method to remove surgical specimen. In this study, we aim to report our experience with in-bag transvaginal specimen retrieval after laparoscopic myomectomy over the past 15 years.Design: Single-center retrospective analysis.Setting: Academic hospital.Patients: Women who underwent laparoscopic myomectomy from January 2005 to April 2021.Intervention: Posterior colpotomy and in-bag transvaginal extraction of the surgical specimen.Measurements and Main Results: We collected and analyzed data about patients' characteristics, main indication for sur-gery, and intra-and postoperative (within 30 days) complications.Results: A total of 692 women underwent transvaginal specimen retrieval after laparoscopic myomectomy (mean largest myoma diameter: 6.64 +/- 2.21 cm; mean specimen weight: 177 +/- 140 g; mean operative time: 84.1 +/- 37.1 minutes; mean blood loss: 195 +/- 191 mL). Within 30-days, we reported the following colpotomy-related complications: a total of 4 cases (0.6%) of vaginal bleeding, 3 of which resolved spontaneously (1 case required readmission with new colporrhaphy under general anesthesia), and 2 cases (0.3%) of vaginal pain, with no underlying cause identified on physical examination and pelvic ultrasound. Specimen weight was positively correlated with longer operative time, intraoperative blood loss, and length of hospital stay.Conclusion: Posterior colpotomy and in-bag transvaginal extraction can be considered a feasible option for retrieval of sur-gical specimens after laparoscopic myomectomy. Journal of Minimally Invasive Gynecology (2022) 29, 1331-1338. (c) 2022 AAGL. All rights reserved.