Comparison of morcellator and culdotomy for extraction of uterine fibroids laparoscopically

Objective To define a rational guideline for the removal of uterine fibroids after laparoscopic myomectomy (LM) by culdotomy or morcellator in multiparae. Study design 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 15 mm 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 10 cm, the morcellator was significantly faster compared to culdotomy (10 min versus 12 min, p < 0.001). For fibroids 10 cm and above, there was no significant difference in time by culdotomy compared to morcellator (24 min versus 20 min, p = 0.497). The electromechanical morcellator was significantly more expensive. Conclusion Fibroid size of 10 cm may be used as a guide for the route of fibroid removal; below 10 cm the morcellator is faster but more expensive, for fibroids 10 cm and above, culdotomy can be considered as it has a similar removal time to the morcellator in multiparae.