EP28.08: Ultrasound preoperative evaluation in the prediction of laparoscopic myomectomy complications

Abstract

To investigate whether a preoperative detailed transvaginal ultrasound evaluation can predict complications during and after laparoscopic myomectomy. This prospective study included women of reproductive age with a single symptomatic fibroid, classified as type 4,5 or 6 according to FIGO classification, scheduled for laparoscopic myomectomy. Transvaginal scanning was performed one month before surgery by the same technician who collected ultrasound data regarding the uterus (volume and vascularisation, considering uterine arteries PI and RI) and the fibroid (type, position, main diameter, volume and vascularisation, considering supplying vessel PI and RI). Surgery was performed by a second physician and the outcome parameters considered were: surgical time, intraoperative blood loss, pre-and post-operative hemoglobin, use of abdominal drains, duration of hospital stay, post-operative fever and need of blood transfusion. 23 women were enrolled in the study. The mean uterine volume was 381.9±189.4 mm3 and it had a correlation with the length of surgery (p=0.045). The mean diameter of fibroids evaluated was 62.2±24.2 mm with a mean volume of 131.7±117 mm3. A significant association was found between fibroid position and surgical time, in particular lateral myomectomies had the longest duration (p=0.049). No other correlations were found among the ultrasound preoperative parameters and the different complications during and after surgery. Dividing myomas in two groups considering their larger diameter, fibroids of 50 mm or more showed higher length of surgery, more blood loss and higher difference between pre and post-operative hemoglobin, but these results did not reach significance (p>0.05). Ultrasound calculation of uterine and fibroid volume can be useful in the estimation of surgical time but determination of uterine and fibroid vascularisation seems not to be a predictor for the risks of complications during and after myomectomy.