Vaginal Removal of the Pedunculated Submucous Myoma: Twisting-off Method

Go, Hee Jung; Baek, Eun Kyeong; Lee, You Sung; Lee, Chang Ho; Kim, Jae Duk; Hwang, Ho Myong; Doo, Jae Kyun

Abstract

OBJECTIVE
To evaluate the efficacy of the twisting-off method in transvaginal removal of the pedunculated submucous myoma.
METHODS
After paracervical block and vaginal dressing with Povidone iodine, the myoma was grasped at its widest diameter and twisted to avulse it from its attatchment. Several kinds of grasping instruments, ie. kelley clamp, tenaculum, ring forcep, was used. If there was bleeding from its detachment site, vaginal gauze or tampon was inserted for bleeding control.
RESULTS
The procedure was perfomed successfully on all 33 patients (100%). In most patients, bleeding was scanty in amount. But in one patient, emergency hysterectomy was performed because of massive uterine bleeding. The myoma varied greatly in size. Largest volume was 62.24 cm3, and mean volume was 13.79 cm3. Pathology revealed classic leiomyomas in most cases. Some showed endocervical polyp or endometrial polyp. Follow up examination was done, and its mean interval was eighteen weeks and no patient was recurred.
CONCLUSION
The transvaginal removal of pedunculated submucous myoma utilizing grasping instruments may be an effective and safe procedure and the complication is minimal. Twisting-off method was may be a safe alternative to abdominal myomectomy and hysterectomy. Reproductive capacity can be preserved, also.