Transvaginal Removal of Adnexal Masses Benefits Patients

Removing specimens transvaginally during laparoscopic resection of adnexal masses is associated with less postoperative pain than transumbilical (TU) removal, according to a new study.¹ Although transvaginal (TV) extraction would eliminate the need for secondary incisions or for a trocar incision enlargement, most surgeons choose not to enter the peritoneal cavity through the vaginal fornix because of concerns of possible adverse effects and a lack of evidence supporting the practice, said the study authors.

To compare TU and TV routes for removal of surgical specimens, researchers randomized women who were undergoing laparoscopic surgery to have adnexal masses removed through either the umbilical port (32 patients) or through a posterior colpotomy (34 patients). Postoperative pain at the incision site was measured at 1 hour, 3 hours, and 24 hours after surgery using a 10-centimeter visual analog scale. Intravenous acetaminophen was used to manage postoperative pain, and rescue analgesia was available on patient request. At an 8-week follow-up, patients rated their overall satisfaction with the surgery and the cosmetic appearance of their scars and were asked if they had dyspareunia.

At 1, 3, and 24 hours after surgery, the umbilicus was rated as the most painful area by 31.2%, 31.2%, and 12.5%, respectively, of women in the TU group and by 5.7%, 2.8%, and 5.7%, respectively, of women in the TV group. In addition, fewer women in the TV group required rescue analgesia (2.8% vs 15.6%). Patient satisfaction ratings at the 8-week follow-up were similar between groups for overall satisfaction, cosmetic outcome, and dyspareunia.
 In the TU group, 3 women required a 1-centimeter extension of the umbilical incision. One patient in the TV group needed the colpotomy incision extended for retrieval of an ovarian fibroma.

Pertinent Points:
- A transvaginal approach for specimen removal after laparoscopic resection of adnexal masses offers the advantage of inducing less postoperative pain without adding operative time and with patient satisfaction rates that compare favorably with those of transumbilical retrieval, say researchers.
- Few, if any, adverse effects related to sexual function were reported by patients who underwent colpotomy at the 8-week follow-up.

References:

1. Ghezzi F, Cromi A, Uccella S, et al. Transumbilical versus transvaginal retrieval of surgical specimens at laparoscopy: a randomized trial. Am J Obstet Gynecol. 2012;207:112.e1-6.