Intraoperative transvaginal ultrasonography during multiple laparoscopic myomectomy

Study Objective: The primary outcome of the study was to assess the usefulness of intraoperative transvaginal ultrasonography (iTVS) during multiple laparoscopic myomectomy (LM) in identifying and removing uterine fibroids. The secondary aim of the study was to assess the value of iTVS in evaluating the quality of the suture performed to close the uterine wall defect. Design: This prospective study included women between 18 and 45 years old with ultrasonographic diagnosis of multiple fibroids (R 3 with mean diameter of at least 1 cm) scheduled for LM. iTVS was used for identifying residual fibroids after standard surgery. An independent ultrasonographer evaluated the quality of the suture by iTVS on the basis of a Likert scale. A follow-up was performed at 1- and 3-month after surgery. Setting: University teaching hospital. Patients: Patients with symptoms related to uterine myomas were elegible. This study included 69 women. Intervention: Patients underwent multiple LM. iTVS was performed to identify residual fibroids after standard surgery. Measurements and Main Results: The mean (` SD) age of the study population was 34.7 ` 3.4 years. A total of 317 myomas were identified before surgery. Forty-five myomas were identified during iTVS; these myomas were identified in 20 patients with preoperative diagnosis of 3 myomas, in 4 patients with 4 myomas, in 3 patients with 5 myomas, in 2 patients with 6 myomas and in one patient with 7 myomas. The mean (` SD) largest diameter of the myomas identified only by iTVS was 2.7 ` 0.7 cm (mean volume: 10.3 ` 7.4 cm3). In 9 patients (13.0%) the quality of the suture was judged to be inadequate by the ultrasonographer and, therefore, it was ameliorated during surgery. At 3-month follow-up, 2 patients had additional myomas not excised during surgery. Conclusion: iTVS improves the detection of uterine myomas during multiple LM and it may improve the quality of uterine defect closure.