Vaginal myomectomy using Duhrseen (longitudinal median cervical) incision: a case seriesof 19 patients

NMUH Staff Publications

<h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif;"><span style="font-size: 10pt;">STUDY OBJECTIVE:</span></h4><p style="margin: 0px 0px 0.5em; font-size: 1.04em; font-family: arial, helvetica, clean, sans-serif;"><span style="font-size: 10pt;">To examine demographics and outcome measures of women having undergone vaginal excision of myoma through Dührssen (longitudinal median cervical) incision DESIGN: Prospective case series DESIGN CLASSIFICATION: The design of the study conforms to Canadian Task Force II3 ie evidence from timed series SETTING: A London teaching hospital PATIENTS: 19 patients with either a) submucus myoma (type 1) located near the cervix or b) pedunculated intracavity myoma (type 0), excised via Dührssen incision INTERVENTIONS: Dührssen (median longitudinal) incision on the anterior or posterior cervical lip MEASUREMENTS: Duration of procedure, intraoperative complications, estimated blood loss, length of stay, % 24 hour discharge, readmission rates RESULTS: Between 2009-16, 19 women had their myomas (submucus type 1, n=17; pedunculated intracavity type 0, n=2) removed vaginally via Dührssen incision. The median age at time of procedure was 46 years (range 43-55) and the commonest indication was menorrhagia which occurred in 90% of cases. The median myoma size was 7 cms (range 6-9), while the median duration of surgery was 60 minutes (range 40-120). Anterior cervical incisions were performed in 60% of cases and 20% of the patients received gonadotrophins for medical debulking of the myomas prior to surgery. One patient sustained a bladder injury which occurred when making the anterior cervical incision. The median length of stay was 8 hours (range 6-36) and the median estimated blood loss was 90 mls (range 50-150). The median duration of follow up was 4 years (range 0.5-6) and no patients had symptoms which were attributable to the procedure.</span></p><h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif;"><span style="font-size: 10pt;">CONCLUSION:</span></h4><p style="margin: 0px 0px 0.5em; font-size: 1.04em; font-family: arial, helvetica, clean, sans-serif;"><span style="font-size: 10pt;">This is a useful technique which complements a minimally invasive surgeon's repertoire and is a viable alternative when hysteroscopic myomectomy is deemed unsuitable due to location and size of the fibroids.</span></p>