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Background To compare the surgical outcomes and costs of in-bag abdominal manual morcellation (AMM) and contained power morcellation (PM) in laparoscopic myomectomy. Methods A total of 61 patients were divided into two groups based on their myomectomy specimen extraction methods: AMM group (n = 33) and electromechanical contained PM group (n = 28). The surgical outcomes and cost were compared between groups. During AMM, a glove bag (in 27 patients) and an endo bag were used (in 6 patients) according to the myoma size. Results Morcellation time (18 ± 9.2 min vs. 37.4 ± 14.1 min) and total operation time (100 ± 24.3 min vs. 127 ± 33.1 min) were significantly lower in the AMM group compared to those in the PM group. Other surgical outcomes, which were similar between groups, included delta hemoglobin, length of hospital stay and VAS score at 12 and 24 h postoperatively. There were no per- or postoperative complications in both group with no conversion to laparotomy. One patient was transfused with two units of erythrocyte suspension postoperatively in the PM group. Sarcoma was not diagnosed in any of the cases in both group. Conclusion The in-bag AMM or contained PM for specimen extraction resulted in similar outcomes in terms of delta hemoglobin, postoperative pain intensity (VAS score at 12 and 24 h postoperatively), the need for additional analgesia, and the length of hospital stay; however, total operation time and morcellation time were significantly shorter in the AMM group, indicating a prominent advantage. Significant cost-effectiveness is also a critical advantage of in-bag AMM compared to containing PM.

Aim In this study, we aimed to evaluate the effect of using two doses of rectal misoprostol on postoperative results in hysteroscopic myomectomy. Methods This retrospective study was carried out at two hospitals in which the medical records of patients who underwent hysteroscopic myomectomy between November 2017 and April 2022 were evaluated, and subjects were grouped depending on the administration of misoprostol before hysteroscopy. In recipients, two rectal doses of misoprostol (400 μg) were administered, 12 h and 1 h before the planned operation. Outcomes evaluated were: postoperative reduction in hemoglobin (Hb), pain at 12 and 24 h (VAS score), and length of hospital stay. Results The mean age of 47 women in the study group was 27.38 ± 5.12 (range 20–38) years. Hb levels reduced significantly in both groups after hysteroscopic myomectomy (p < 0.001). In misoprostol recipients, VAS score was found to be significantly lower at 12 h (p < 0.001) and 24 h after the operation (p = 0.004). Multiple linear regression analyses for each of the outcomes revealed the following: greater myoma size was associated with greater Hb decrease (p = 0.010), misoprostol use was associated with lower 12th and 24th hour VAS scores (p < 0.001), longer duration of operation was associated with higher 12th and 24th hour VAS scores (p < 0.001), and finally, longer duration of operation was associated with prolonged hospital stay (p = 0.001). Conclusions The use of two doses of rectal misoprostol before hysteroscopic myomectomy was effective in reducing postoperative pain. Prospective, population‐based studies evaluating different uses of misoprostol in hysteroscopic myomectomy are needed.

Uterine manipulation is essential for moving the uterus and proper anatomical dissection without complications during total laparoscopic hysterectomy (TLH). Although many different uterine manipulators (UM) have been designed in the last few decades, there is still no “optimal UM” that is universally safe, efficient, and cost-effective. This study aimed to compare myoma screw (MS) and UM with regard to surgical outcomes and cost-effectiveness in patients who underwent TLH. In the current study, we describe an operation technique that uses a MS instead of a uterine manipulator during TLH and discuss the surgical outcomes of this method. The use of MS resulted in significantly shorter operation time with respect to UM for uterine manipulation during TLH regarding benign indications, with affordable costs. The use of MS is a safe and cost-effective alternative to the use of UM during TLH.

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