Simultaneous enucleation and in situ morcellation of myomas in laparoscopic myomectomy

OBJECTIVE: To evaluate the outcome of myoma enucleation by morcellation while it is attached to the uterus (in situ morcellation) in laparoscopic myomectomy. MATERIALS AND METHODS: A total of 82 patients diagnosed with myoma or adenomyosis in 2007 were enrolled. The patients were divided into three groups according to the myoma weight. The operative time, myoma weight, blood loss, duration of hospital stay, and complication experienced were recorded for analysis. RESULTS: The mean myoma weight was 265 ± 240 g and the mean operative time was 93 ± 30 minutes. The patients were divided into three groups: group A with myomas less than 150 g; group B with myomas 150-349 g; and group C with myomas greater than 350 g. The mean myoma weights were 73 ± 34 g, 214 ± 52 g, and 571 ± 218 g for groups A, B, and C, respectively; the mean operative times were 79 ± 17 minutes, 84 ± 22 minutes, and 121 ± 32 minutes, respectively. The operative time increased with myoma weight. Two patients (8%) in group C had excessive intraoperative hemorrhage and one (4%) required a blood transfusion. There was no conversion to laparotomy. CONCLUSION: In situ morcellation was an efficient and safe procedure for removal of large uterine myoma during laparoscopic myomectomy.