Effectiveness of intraoperative ultrasound in reducing recurrent fibroids during myomectomy

Abstract

Reconstructive operations of uterus (ROU) for multiple myomas (MM) are accompanied by high rate of recurrence 40 - 50%, which are caused by residual tumors. The main of this study was to present initial experience of intraoperative ultrasound (IOUS) guidance during ROU for MM. Material and methods: The prospective study were based on 78 consecutive patients with MM, the age were 20 - 44 years (mean 32.6 70.52), whom were performed ROU with IOUS. Clinical criteria included in study were diagnosed on clinical examination, transabdominal US, CT scan, MRI. IOUS was done using an 8-MHz curved - array sector transducer attached to a “Toshiba Just Vision 200 (Model SSA-320A, Tokyo, Japan)” for (1) detecting nonpalpable nodules, (2) to defined relation between myomas and uterine cavity, uterine vessels (criteria’s were published previously (Mishina A., Gyn. Surg. 2005; 3; 223 - 225). Results: In 37 (47.3%) cases axial and sagital images of the uterus revealed additional non-palpable small myomas less than 2.0 cm, situated intramural and submucosal, in 34 cases (43.5%) were opened uterine cavity, especially for submucosal myomas. Postoperative recurrence, morbidity and mortality was zero. Our case highlights the efficient application of IOUS in open reproductive procedures for MM, which allows determining the completeness of nodule excision less than 2 cm in diameter; examinations of myometrium in preventing residual myomata; defining the locations of nodules to uterine artery and cavity.