Pierce and Push: A Simplified Method to Facilitate Laparoscopic Myomectomy

Background: The aim of this study was to present our experience with a novel approachcalled the pierce and push (PP) method which uses a stainless steel centimeter probe instead of a 5 mm claw forceps to enucleate fibroids in a laparoscopic myomectomy (LM).Methods: A retrospective chart review of 90 women with symptomatic uterine fibroidswho underwent an LM was performed. Cases of LM with the PP methodwere compared with a matched control group of LM with a 5 mm claw forceps. The operative time, tumor separation time, specimen removal time,amount of blood loss, requirement for blood transfusion and length of hospital stay were compared between groups.Results: The two groups were matched by age, body mass index, previous cesareandelivery, main fibroid size, and number and weight of fibroids. The tumorseparation time was significantly shorter in the PP group than the claw forceps group (9.7 3.1 minutes versus 17.1 4.4 minutes, p < 0.001). Thelength of the operation, hospitalization time, specimen removal time, amountof blood loss, and requirement for blood transfusion were not significantlydifferent between groups.Conclusion: A stainless steel centimeter probe has an advantage over a 5 mm claw forceps in pushing and pulling fibroids. Our findings indicate that the PPmethod was much more effective in excision of fibroids than a 5 mm clawgrasper in LM.