Operative outcomes of single-port-access laparoscopy-assisted vaginal hysterectomy compared with single-port-access total laparoscopic hysterectomy.

OBJECTIVE: This study aims to compare between operative outcomes of single-port-access laparoscopy-assisted vaginal hysterectomy (SPA-LAVH) and single-port-access total laparoscopic hysterectomy (SPA-TLH), further subdivided by vaginal cuff closure via laparoscopic suture (VCC-L) or via the vaginal route (VCC-V). MATERIALS AND METHODS: A custom-made port was used for single-port laparoscopy in 111 patients who underwent SPA-LAVH (n = 33), SPA-TLH with VCC-L (n = 35), and SPA-TLH with VCC-V (n = 43) during October 2009-October 2010. Records were reviewed retrospectively. RESULTS: A significant difference in the operating time was observed among the groups (p = 0.009). SPA-TLH with VCC-L took a significantly longer time to be performed (118.6 ± 41.8 minutes) than SPA-TLH with VCC-V (98.6 ± 21.3 minutes) or SPA-LAVH (102.0 ± 20.3 minutes). The decrease in hemoglobin level on the 1(st) day postsurgery was significantly smaller in case of SPA-LAVH (1.56 ± 0.97 g/dL, p = 0.005) compared with that in case of SPA-TLH with VCC-L (2.19 ± 0.95 g/dL) and SPA-TLH with VCC-V (2.24 ± 0.95 g/dL). No significant differences in other surgical outcomes were found. CONCLUSION: SPA-TLH with laparoscopic vaginal suture required the longest operating time, and hemoglobin changes were smaller in the SPA-LAVH group than in the other groups. In patients undergoing SPA laparoscopy, we recommend the SPA-LAVH procedure.

Laparoscopic salpingotomy using the floseal hemostatic sealant in patients with tubal pregnancy.

BACKGROUND: To present our initial experience with laparoscopic salpingotomy using the Floseal™ (Baxter International Corp., Deerfield, IL) hemostatic matrix for tubal pregnancy and to evaluate the efficacy and tubal patency after salpingotomy. MATERIALS AND METHODS: A prospective study was conducted on 20 consecutive patients with tubal pregnancy undergoing laparoscopic salpingotomy using the Floseal hemostatic matrix. The outcome measures were treatment success rates and homolateral patency rates. RESULTS: Of 20 cases, 19 cases (95%) were successfully performed without any additional intervention, and 1 case was switched to salpingectomy during the initial surgery. During the mean ß-human chorionic gonadotropin resolution time of 17.9±6.4 days, postoperative complications or persistent trophoblasts did not occur. Of 19 salpingotomy patients, only 12 patients received a tubal patency test using hysterosalpingography, and the homolateral tubal patency rate was 75% (9 of 12). CONCLUSIONS: The use of Floseal allows laparoscopic salpingotomy to be performed successfully and easily with comparable outcomes.

Laparoendoscopic single-site surgery for extremely large ovarian cysts: a feasibility, safety, and patient satisfaction study.

BACKGROUND/AIMS: To assess the feasibility, safety and patient satisfaction of laparoendoscopic single-site (LESS) surgery for extremely large ovarian cysts. METHODS: We conducted a prospective study of LESS surgery among women with ovarian cysts with a minimum diameter ≥15 cm and with radiological and laboratory features suggestive of benign disease. The primary outcomes were perioperative complication rate, conversion rate and patient satisfaction. RESULTS: A total of 21 consecutive patients underwent the following LESS surgery over a period of 17 months: ovarian cystectomy (76%), adnexectomy (10%) and staging procedure (14%). Histological findings included benign (85%), borderline (10%) and malignant tumors (5%). Spillage occurred for 2 patients (10%). LESS surgery was successful without conversion in 20 patients (95%). There was 1 perioperative complication with subcutaneous hematoma (5%). The median operative time and estimated blood loss were 79.8 min (39-155) and 60 ml (10-180), respectively. Patients were highly satisfied with the results of LESS surgery, with a mean surgery satisfaction score of 9.4 ± 0.8 on a scale of 1-10. More than 71% of patients reported that the scar was invisible, and 95% said that they would recommend LESS surgery to others. CONCLUSION: Based on our results, with proper patient selection, the size of an ovarian cyst does not necessarily constitute a contraindication for LESS surgery.

Effectiveness of different routes of misoprostol administration before operative hysteroscopy: a randomized, controlled trial.

OBJECTIVE: To compare the effectiveness and patient preference of different routes of misoprostol administration before operative hysteroscopy in premenopausal women. DESIGN: Randomized, controlled trial. SETTING: University hospital. PATIENT(S): One hundred sixty women undergoing operative hysteroscopy. INTERVENTION(S): Patients were randomly assigned to receive 400 µg misoprostol orally (n=40), sublingually (n=40), or vaginally (n=40) before operative hysteroscopy; the control group (n=40) did not receive any cervical priming agent. MAIN OUTCOME MEASURE(S): Preoperative cervical width, adverse effects, and patient preference. RESULT(S): The mean (±SD) cervical widths for the oral, sublingual, vaginal, and control groups were 7.62±1.81 mm, 7.58±1.77 mm, 7.60±2.15 mm, and 5.65±2.12 mm, respectively, which was statistically significant. Time to cervical dilatation was also significantly longer in the control group than in the other three groups. Misoprostol-related adverse effects and hysteroscopy-related complications were comparable among the four study groups. Of all 160 subjects, 132 (82%) preferred the oral route for misoprostol administration to the sublingual or vaginal routes, or had no preference. CONCLUSION(S): All orally, sublingually, and vaginally administrated misoprostol is equally effective in inducing proper cervical priming before operative hysteroscopy. Considering patient preference, oral administration may be the optimal route for misoprostol administration. CLINICAL TRIAL REGISTRATION NUMBER: NCT01805115.

Is myomectomy in women aged 45 years and older an effective option?

OBJECTIVES: The aim of this study was to evaluate the recurrence and reoperation rate after myomectomy in women aged 45 years and older, who want to preserve their uterus. STUDY DESIGN: We performed a retrospective review of women aged ≥45 years that underwent myomectomy between January 2000 and December 2010. The inclusion criteria were premenopausal status, myomectomy through abdominal or laparoscopic surgery, and at least 12 months interval from surgery. The clinical outcomes, including symptomatic change, recurrence of myoma on transvaginal ultrasonography (TVS), and reoperation data were collected and analyzed. RESULTS: A total 92 patients were included in this study. The median age of the patient was 47 years (range 45-53 years), and the median follow-up duration was 30.5 months (range 12-95 months). On follow-up TVS, the recurrence of myoma was detected in 20 of 82 (24.4%) patients. Ten (10.9%) patients were not subjected to follow-up TVS. However, during their pelvic examination, the uterus was normal size, and all the 10 patients experienced symptomatic improvement and none of them needed additional surgical management. Using the Kaplan-Meier method, the cumulative recurrence rate at 36 months after myomectomy was calculated as 17.1%. Three patients underwent hysterectomy during the follow-up periods, and only one underwent hysterectomy due to myoma. The overall reoperation rate after myomectomy in this age group was 3.3%, and the reoperation for myoma rate was only 1.1%. CONCLUSION: Considering the natural regression of myoma after menopause, myomectomy might be an effective option for women aged 45 years and older, who want to preserve their uterus.

Impact on ovarian reserve after laparoscopic ovarian cystectomy with reduced port number: a randomized controlled trial.

OBJECTIVES: Single-port access (SPA) laparoscopic ovarian cystectomy has been reported as a comparable procedure to conventional laparoscopy in terms of operative outcomes. However, whether ovarian function after SPA laparoscopic surgery is similar to conventional laparoscopy is questioned due to the limitations in moving instruments. The aim of this study was to evaluate whether the reduced port number affects the ovarian reserve after laparoscopic ovarian cystectomy. STUDY DESIGN: This was a randomized controlled trial of 87 women with benign ovarian cyst, who attended a university hospital and were scheduled for laparoscopic ovarian cystectomy. Women were randomized to SPA, two-port access (TPA), or four-port access (FPA) laparoscopic groups. The primary outcome was the serum anti-Müllerian hormone (AMH) levels: preoperative, 1 week, 1 month and 3 months after the operation. Secondary outcomes were operative outcomes. RESULTS: The mean serum AMH levels of preoperative, 1 week, 1 month and 3 months after laparoscopy were 4.4±2.9, 2.7±2.2, 2.3±1.9, and 2.5±1.5ng/mL (in the SPA group), 3.6±2.5, 2.3±2.2, 2.6±3.2, and 2.7±2.6ng/mL (in the TPA group), and 3.9±3.2, 2.4±2.1, 2.5±2.0, and 2.8±2.2ng/mL (in the FPA group), respectively. There was no statistically significant difference in the serial change of AMH levels among the SPA, TPA and FPA groups. CONCLUSIONS: The laparoscopic ovarian cystectomy with reduced port number does not affect the serial change of ovarian reserve. The SPA or TPA laparoscopy may be the alternative method to conventional laparoscopy in terms of ovarian reserve.

Risk factors for treatment failure of CO2 laser vaporization in cervical intraepithelial neoplasia 2.

PURPOSE: The aim of our study was to evaluate the risk factors for treatment failure of CO2 laser vaporization in patients with cervical intraepithelial neoplasia 2 (CIN2). METHODS: Medical records of patients who received either shallow or deep CO2 laser vaporization with biopsy-proven CIN2 during March 2007 to April 2011 were reviewed retrospectively. After laser vaporization, liquid-based cytology and human papilloma virus (HPV) DNA testing were checked in every follow-up visit. Treatment failure was defined when the follow-up biopsy was more than CIN2, needing secondary surgical treatment. RESULTS: During that period, 141 patients with CIN2 underwent CO2 laser vaporization. After laser ablation, 14 of 141 women needed the secondary treatment, a success rate of laser vaporization of 90.1 %. In multivariate analysis, the previous loop electrosurgical excision procedure (LEEP) history (adjusted OR = 13.649; P value = 0.025) and the ablation depth (adjusted OR = 11.279; P value = 0.006) were independent factors associated with treatment failure. CONCLUSION: Both ablation depth and previous LEEP history were the important factors increasing the risk for the treatment failure of CO2 laser vaporization in CIN2.

Would fewer port numbers in laparoscopy produce better cosmesis? Prospective study.

STUDY OBJECTIVE: To determine whether fewer ports in laparoscopic adnexal surgery would lead to better cosmesis. DESIGN: Prospective comparative study (Canadian Task Force classification II-2). SETTING: University hospital. PATIENTS: One hundred thirty consecutive patients with adnexal tumors. INTERVENTIONS: Patients underwent laparoscopy using a single port (n = 75), 2 ports (n = 22), or 4 ports (n = 33). Cosmetic satisfaction was assessed using a validated Body Image Questionnaire at 1, 4, and 12 weeks after surgery. MEASUREMENTS AND MAIN RESULTS: Patient characteristics (age, parity, and sociodemographic data), details of the procedures performed, and histologic findings were similar between the 3 surgical groups. There was also no difference in number of conversions to other surgical approaches, operative time, estimated blood loss, postoperative pain, and perioperative complications. Compared with the 2- and 4-port groups, the single-port group reported substantially greater cosmetic satisfaction at 1, 4, and 12 weeks after surgery. However, there was no important difference in cosmetic outcome throughout follow-up in the 2-t and 4-port groups. CONCLUSION: Unlike 2- or 4-port laparoscopy, single-port laparoscopy has a definite benefit in cosmetic satisfaction.

Laparoendoscopic single-site versus conventional laparoscopic gynecologic surgery: a metaanalysis of randomized controlled trials.

OBJECTIVE: To assess the current evidence regarding the efficiency, safety, and potential advantages of laparoendoscopic single-site surgery (LESS) for treating gynecologic diseases. STUDY DESIGN: We comprehensively searched PubMed, Embase, and the Cochrane Library from their inception to December 2012. Two authors screened out duplicates and independently reviewed eligibility of each study. We included randomized controlled trials comparing LESS with conventional laparoscopy (CL) for treating gynecologic diseases. The primary outcomes were perioperative complication rate, conversion rate, postoperative pain, and cosmetic satisfaction. RESULTS: We included 6 randomized controlled trials with 439 participants in the final analysis. There were no significant differences between LESS and CL in terms of perioperative complication rate (15.5% and 14.3%; risk ratio, 1.11; 95% confidence interval [CI], 0.74-1.67; P = .61), conversion rate (3.8% and 1.1%; risk ratio, 2.75; 95% CI, 0.73-10.33; P = .13), postoperative pain (weighted mean difference [WMD], -0.22; 95% CI, -1.29 to 0.85; P = .68), analgesic requirement (WMD, 0.41; 95% CI, -1.69 to 2.51; P = .70), and cosmetic satisfaction (WMD, 0.19; 95% CI, -0.30 to 0.68; P = .46). There were also no differences in terms of operative time (P = .65), hemoglobin change (P = .23), time to first flatus (P = .17), and length of hospital stay (P = .99) between both techniques. CONCLUSION: This metaanalysis provides evidence that LESS is comparable in the efficacy and safety, but does not offer potential advantage such as better cosmesis and lesser pain compared with CL for treating gynecologic diseases.

Comparison of dilatation & curettage and endometrial aspiration biopsy accuracy in patients treated with high-dose oral progestin plus levonorgestrel intrauterine system for early-stage endometrial cancer.

OBJECTIVE: To compare the diagnostic accuracy of dilatation & curettage (D&C) vs. endometrial aspiration biopsy in follow-up evaluation of patients treated with high-dose oral progestin plus levonorgestrel intrauterine system (LNG-IUS) for early-stage endometrial cancer (EC). METHOD: A prospective observational study was conducted with 11 patients with FIGO grade 1 or 2, clinical stage IA endometrioid adenocarcinoma. Patients were aged up to 40 years wishing to preserve fertility treated with high-dose oral progestin plus LNG-IUS. Treatment response assessment was done at three month intervals. Endometrial tissues were obtained via endometrial aspiration biopsy with LNG-IUS in place and D&C after removal of LNG-IUS. We identified 28 cases; the histologic results were compared. Kappa statistics were used to assess the agreement of two methods. RESULTS: Diagnostic concordance between examinations was assessed for 9 out of 28 cases examined (32.1%). These consisted of three cases with both examination results of normal, 3 cases with endometrioid adenocarcinoma, 1 case with complex endometrial hyperplasia, 2 cases with material insufficient for diagnosis. Endometrioid adenocarcinoma on D&C was diagnosed in 9 out of 28 cases, but from endometrial aspiration biopsy, only 3 of these 9 cases were diagnosed with endometrioid adenocarcinoma, giving the diagnostic concordance at 33% (kappa value=0.27). From endometrial aspiration biopsy, 17 out of 28 cases (60.7%) had material insufficiency for diagnosis. CONCLUSION: In patients treated with high-dose oral progestin plus LNG-IUS for early-stage EC, endometrial aspiration biopsy with LNG-IUS in place may be not reliable as a follow-up evaluation method.

Comparison of single-port, two-port and four-port laparoscopic surgery for cyst enucleation in benign ovarian cysts.

OBJECTIVE: To compare the perioperative outcomes of three laparoscopic approaches for performing ovarian cyst enucleation. METHODS: A total of 148 patients underwent laparoscopic cyst enucleation at the CHA Gangnam Medical Center between September 2010 and May 2011. We reviewed retrospectively the medical records including patient demographics, operative outcomes and complications. RESULTS: We assigned the 148 patients into three groups: single-port (group A: 40), 2-port (group B: 30) and 4-port (group C: 78). There were no statistically significant differences in patient characteristics. The operation times were 90.4 ± 43.6, 74.7 ± 22.0 and 63.8 ± 30.5 min, and the estimated blood loss was 179.3 ± 253.9, 73 ± 75.2 and 89.9 ± 106.7 ml, respectively. Mean operation time was longer (p < 0.001) and estimated blood loss was higher (p = 0.005) in group A than in the other groups. There was no statistical difference in perioperative complications among the three groups. In group A, additional port insertion rate was higher than in groups B and C (p < 0.001). CONCLUSION: Single-port surgery required longer operation time, had a higher estimated blood loss and used additional ports more frequently during the operation than the other groups. However, 2-port surgery had no significant differences from 4-port surgery in the surgical outcomes. Therefore, 2-port surgery can be an alternative surgical option for 4-port surgery in ovarian cyst enucleation.

Combined medroxyprogesterone acetate/levonorgestrel-intrauterine system treatment in young women with early-stage endometrial cancer.

OBJECTIVE: The purpose of this study was to evaluate the efficacy of the combined oral medroxyprogesterone acetate (MPA)/levonorgestrel-intrauterine system (LNG-IUS) treatment in young women with early-stage endometrial cancer who wish to preserve their fertility. STUDY DESIGN: A prospective observational study was conducted. The study population comprised women aged ≤40 years who were diagnosed with endometrioid endometrial cancer, grade 1, tumor size <2 cm presumably confined to the endometrium. A LNG-IUS was inserted in the uterine cavity of each woman, and all of the women received oral MPA (500 mg/d). Dilation was conducted every 3 months. RESULTS: From September 2008 to December 2012, 16 patients were enrolled. The overall complete remission rate was 87.5% (14/16 patients); the average time to complete remission was 9.8 ± 8.9 months (range, 3-35 months). In the initial 3 months of treatment, complete remission was observed in 25% of cases (4/16 patients), partial response in 25% (4/16), and no change in 50% (8/16); there were no cases of progressive disease. Three patients achieved pregnancies. The average follow-up period was 31.1 ± 11.8 months (range, 16-50 months), and there were no treatment-related complications. CONCLUSION: Combined oral MPA/LNG-IUS treatment is considered to be effective and favorable for young patients with early-stage endometrial cancer who want to preserve their fertility.

Single-port access total laparoscopic hysterectomy for large uterus.

BACKGROUND/AIMS: To evaluate the feasibility and safety of single-port access total laparoscopic hysterectomy (SPA-TLH) for large uterus (>500 g). METHODS: A prospective data collection was performed in 21 consecutive patients in March 2010 and August 2011. Surgical outcome including operative time (OT) and estimated blood loss (EBL) were analyzed. RESULTS: SPA-TLH procedures were successfully performed in 16 cases (76.2%). Of the 5 failed cases, 4 were converted to multiport TLH because of distorted uterine contours and pelvic adhesions and 1 was converted to laparotomy for bleeding control. The median OT, uterine weight, and EBL were 110 (65-165) min, 600 (502-980) g, and 200 (100-800) ml, respectively. Spearman's correlation analysis demonstrated that OT and blood loss increased with increasing uterine weight (p = 0.003 and p = 0.033, respectively). No operative complications were observed during the hospital stay and 3-month follow-up following discharge. CONCLUSION: SPA-TLH for large uterus is a feasible and safe technique.

Intraoperative intraperitoneal chemotherapy with cisplatin in epithelial ovarian cancer.

OBJECTIVE: To assess retrospectively the feasibility of intraoperative intraperitoneal (IP) chemotherapy with cisplatin in epithelial ovarian cancer. METHODS: IP chemotherapy during optimal staging surgery was performed in 10 patients who were diagnosed with primary epithelial ovarian cancers between April 2008 and February 2011. Cisplatin (70 mg/m(2) in 1 L normal saline solution) was administered in the abdominal cavity for 24 hours postoperatively and then adjuvant chemotherapy was started 2-4 weeks after surgery. Perioperative toxicity of the combined treatment was evaluated until the initiation of postoperative adjuvant chemotherapy. RESULTS: A total of 23 adverse events were observed in 9 of 10 patients (grade 1, 7; grade 2, 13; grade 3, 3; grade 4, 0). In descending order of frequency, adverse events affected the gastrointestinal system (n=14), hematologic system (n=6), pulmonary system (n=2), and genito-urinary system (n=1). The adverse events did not affect adjuvant systemic chemotherapy schedules. One patient experienced disease recurrence in the liver 16 months after surgery. The remaining 9 patients have been well controlled by chemotherapy and/or observation during the follow-up period of 4 to 39 months after surgery. CONCLUSION: Intraoperative IP chemotherapy with cisplatin during surgical procedures is considered feasible for the treatment of primary epithelial ovarian cancer. Further studies, including long-term, prospective and comparative trials, are needed to validate the efficacy of this combined therapy.

Effectiveness of high-dose progestin and long-term outcomes in young women with early-stage, well-differentiated endometrioid adenocarcinoma of uterine endometrium.

PURPOSE: We assessed the effectiveness of high-dose progestins as a conservative treatment in young women with endometrial adenocarcinoma. METHODS: We retrospectively reviewed the hospital data of patients with endometrial cancer that were managed conservatively. Of those women with grade 1 endometrioid endometrial adenocarcinoma, we included those who were younger than 40 years and in whom the disease was clinically confined to the endometrium. A complete response was defined pathologically as the absence of tissue with adenocarcinoma or hyperplasia. RESULTS: Fourteen patients were included. Their mean age was 30.0 ± 4.8 years and the mean follow-up period was 47.3 ± 29.7 months. Twelve patients received 30-500 mg/day medroxyprogesterone acetate and two received 160 or 240 mg/day megestrol acetate. The median duration of treatment was 6 months (range 3-15 months) and 13 (93%) patients showed a complete response. Endometrial pathology reappeared in four patients (4/13, 31%) including two relapses, three of whom developed after the patients gave birth. Six patients used a combined oral contraceptive or a progestin-releasing intrauterine device as a maintenance therapy and experienced no recurrence. Four women (4/7, 57%) conceived successfully seven times with assisted-reproductive technology. No adverse effects of the progestins or tumor-related death were noted. CONCLUSIONS: High-dose progestin therapy can be an effective conservative treatment in young patients with well-differentiated early-stage endometrial cancer. If patients wish to preserve their fertility even after they have completed childbearing, maintenance therapy with a cyclic oral contraceptive or a progestin-releasing intrauterine device may be an option to prevent recurrence.

Single-port versus conventional laparoscopic salpingectomy in tubal pregnancy: a comparison of surgical outcomes.

OBJECTIVE: To compare the surgical outcomes of single-port laparoscopic salpingectomy (SPLS) and conventional laparoscopic salpingectomy for the surgical treatment of tubal pregnancy. STUDY DESIGN: From January to June 2009, patients with tubal pregnancy were assigned to two surgical groups: SPLS and conventional laparoscopic salpingectomy. Surgical outcomes, including operative time, postoperative haemoglobin drop, hospital stay and complications, were compared prospectively. For SPLS, a novel multichannel port was made using a wound retractor and a surgical glove. RESULTS: In total, 60 patients were enrolled in the study (30 in the SPLS group and 30 in the conventional group). All operations were completed successfully. No significant difference was observed between the two groups in terms of mean operative time (52.6 ± 16.1 min vs 46.8 ± 16.2 min; p=0.174), mean difference between pre- and postoperative haemoglobin (1.7 ± 0.8 g/dl vs 1.8 ± 1.0 g/dl; p=0.636), or mean postoperative hospital stay (2.4 ± 0.5 days vs 2.4 ± 0.9 days; p=1.000). No complications were encountered in either group, and there was no conversion to conventional laparoscopy in the SPLS group. CONCLUSION: SPLS has comparable surgical outcomes to conventional laparoscopic salpingectomy for the surgical treatment of tubal pregnancy in terms of operative time, hospital stay and complication rates. However, further studies are needed to evaluate the merits expected of single-port laparoscopic surgery, such as cosmetic advantage and decreased pain in patients.

Conservative treatment with medroxyprogesterone acetate plus levonorgestrel intrauterine system for early-stage endometrial cancer in young women: pilot study.

OBJECTIVE: To assess the feasibility of using medroxyprogesterone acetate (MPA) and levonorgestrel intrauterine system (LNG-IUS) to treat early-stage endometrial cancer in young women who want to preserve their reproductive potential. METHODS: Prospective observational study of 5 young patients (mean [SD] age, 38.4 [4.8] years; range, 33-41 years) with a grade 1 endometrial cancer that is presumably confined to the endometrium. The subjects were given a daily oral dose of 500 mg of MPA and LNG-IUS placement. They were followed with dilation and curettage every 3 months. RESULTS: Complete remission was shown in 4 of 5 patients, and one patient showed partial remission. Biopsy results were negative in 2 patients at 3 months, in 1 patient at 6 months, and in 1 patient at 12 months. No treatment-related complications occurred. No recurrence was found during the follow-up period (mean [SD], 10.2 [3.6] months; range, 6-16 months). CONCLUSIONS: The concomitant use of MPA with LNG-IUS is feasible for conservative treatment of early-stage endometrial cancer in young women who want to preserve their reproductive potential.

Spontaneous vaginal expulsion of uterine myoma after magnetic resonance-guided focused ultrasound surgery.

Uterine myomas are common benign uterine tumors in women of reproductive age. Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is a minimally invasive procedure that produces coagulative necrosis at a precise focal point within the body. MRgFUS regarded as an effective and safe treatment modality in women with symptomatic uterine myomas. Vaginal passage of treated myoma tissue has been reported during other therapeutic procedures such as uterine artery embolization or during puerperium. This study is the first to report a case of vaginal expulsion of uterine myoma after MRgFUS, with complete endometrial recovery on follow-up.