Abstract
INTRODUCTION: Vaginal myomectomy (VM) is a minimally-invasive surgery to remove uterine fibroids; however, limited exposure, difficulties in suturing, and challenges in achieving hemostasis restrict its wider adoption. To address these limitations, the Sahin transvaginal extracorporeal (STVEC) technique was developed, allowing for complete uterine exteriorization for extracorporeal reconstruction. AIM: We aimed to evaluate the safety, feasibility, and perioperative outcomes of the STVEC technique in women undergoing surgery for symptomatic uterine myomas. MATERIALS AND METHODS: This retrospective cohort included 200 consecutive patients who underwent VM using the STVEC technique between February 2021 and October 2024. Demographic characteristics, myoma features according to the International Federation of Gynecology and Obstetrics (FIGO) classification, operative variables, postoperative outcomes, and complications were analyzed. The complications were graded using the Clavien-Dindo system. Conversion to laparotomy was performed when safe continuation of the STVEC approach was not feasible. RESULTS: Mean (SD) age of the study cohort was 39.1 (6.5) years and mean (SD) body mass index was 27.5 (5.8) kg/m². Mean (SD) myoma count was 1.8 (1.4; range: 1-5) and mean (SD) diameter was 6.7 (2.4; range, 5-10) cm. Intramural myomas (FIGO type 2-5) were the most common (55%). Conversion to laparotomy occurred in 8 patients (4%) due to adenomyotic uteri, adhesions, prior vaginal surgery, or altered cervical anatomy. Median (interquartile range [IQR]) hemoglobin decrease was 1.7 g/dl, median (IQR) estimated blood loss was 180 ml, and mean (SD) operative time was 71.9 (19.5) minutes. Blood transfusion was required in 18 patients (9%). Early complications occurred in 7 participants (3.5%), and all were minor. CONCLUSIONS: The STVEC technique appears safe and feasible, offering good bleeding control, low complication rates, and rapid recovery. Further multicenter studies are needed to confirm our findings.