Abstract
Video Objective This video discusses the use of preoperative Magnetic Resonance Imaging (MRI) to optimize surgical planning of laparoscopic myomectomies in patients with multiple fibroids desiring future fertility. Setting University hospital that serves as a referral center for patients desiring myomectomies. We will present two patients with multiple fibroids and infertility who elected to undergo surgical intervention. MRI's were obtained and we will highlight the use of imaging to assist in the surgical planning of the myomectomy procedure. Interventions For both patients, preoperative pelvic MRI (with and without contrast) was performed. Multiple fibroids were found and T2 images in 3 planes were used to map fibroid location in relation to key anatomical structures (Endometrium, cornua, cervix, etc). This critical information allows for efficient intra-operative management and resection of fibroids reducing the risk of recurrence. Anticipating endometrial involvement may allow for resection without compromising the integrity of the endometrial cavity which could have a significant impact on fertility and mode of delivery. Conclusion In the setting of 4 or more fibroids, MRI is likely superior to ultrasound for the purposes of preoperative planning. Mapping techniques helps surgeons plan efficient resection of the pathology to optimize surgical outcomes.
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