The Role of Pelvic Ultrasound in Preoperative Evaluation for Laparoscopic Myomectomy

Study Objective

To determine the accuracy of pelvic ultrasonography (US) in preoperative evaluation before laparoscopic myomectomy.

Design

A prospective cohort study (Canadian Task Force classification II-2).

Setting

A tertiary level referral center of minimally invasive gynecologic surgery, Sant'Orsola University Hospital, Bologna, Italy.

Patients

One hundred one of the 125 women undergoing laparoscopic myomectomy from September 2015 to May 2016 were included.

Interventions

Preoperative pelvic US was performed 2 weeks before surgery.

Measurements and Main Results

Among the 101 women enrolled in this study, preoperative US correctly identified the number of myomas in 73 patients (72.3%). A total of 208 myomas were preoperatively identified by US; 197 (94.7%) were surgically removed, and 11 (5.3%) were not visualized during laparoscopic myomectomy. The 11 undetected myomas were intramural (International Federation of Gynecology and Obstetrics [FIGO] type 3 and 4), with a mean diameter of 19.05?±?5.91?mm. The type, site, and location of the 197 myomas identified by US preoperatively and removed via laparoscopy were confirmed at surgery in 78.7% (155/197), 80.7% (159/197), and 84.3% (166/197) of the cases, respectively. Two-hundred fifty-four total myomas were removed laparoscopically; 197 (77.6%) were preoperatively identified by US, and 57 (22.4%) were missed by US, having had a mean diameter of 13.51?±?7.84?mm and predominantly being the subserosal type (FIGO type 5, 6, and 7) (57.9%, p?

Conclusion

Pelvic US is a valuable tool in preoperative evaluation and should be systematically performed when planning laparoscopic myomectomy.