Vaginal Leiomyomas - Safe Steps for Laparoscopic removal: feasibility from 3 case reports.

Background: Leiomyomas are a common pathology in reproductive-aged women. However, they rarely originate from extrauterine sites. Vaginal leiomyomas constitute a challenging diagnosis, regarding their surgical treatment. Despite the well- established advantages of laparoscopic myomectomy, the efficacy and feasibility of a total laparoscopic approach for such cases has not been yet investigated.

Objectives: To describe step-by-step the laparoscopic technique for vaginal leiomyoma removal (narrated video presentation) and demonstrate the outcomes of a small series managed at our institution.

Patients: Three patients diagnosed with symptomatic vaginal leiomyomas that presented to our laparoscopic department. Patients aged 29, 35 and 47 years with BMI 20.6 kg/m2, 19.5kg/m2 and 30.1 kg/m2, respectively.

Results: Total laparoscopic excision of the vaginal leiomyomas was successful in all three cases without conversion to laparotomy. The technique is demonstrated in a step-by-step video narration. There were no major complications. Average operative time was 146.25 min (range 90- 190 min) and intraoperative blood loss was 120 ml (range 20-300ml). Fertility was preserved in all patients.

Conclusion: Laparoscopy is a feasible technique to approach vaginal masses. Further studies are needed to assess safety and efficacy of the laparoscopic technique in such cases.