Effectiveness of intraoperative ultrasound in reducing recurrent fibroids during laparoscopic myomectomy.
OBJECTIVE
To detect and study residual fibroids, their recurrence after laparoscopic myomectomy (LM) and the risk factors.


METHODS
A prospective analysis (Canadian Task Force classification II-1) was conducted at a university-affiliated hospital. A total of 42 patients who underwent LM underwent contact ultrasonography (CUS) and transvaginal ultrasonography (TVUS) to detect residual fibroids. After LM, additional enucleation guided by CUS was performed, and then the final residual fibroids were detected using TVUS. The frequency of postoperative residual fibroids and their characteristics were evaluated. All cases were followed for > 6 months postoperatively to assess recurrence.


RESULTS
The total number of fibroids enucleated in the initial enucleation was 201, or 4.8 per patient. Median diameter of the largest fibroids for each patient was 60 mm. There were 25 additional fibroids enucleated with CUS guidance. Their median diameter was 12.1 mm. After the additional enucleation, 33 final residual fibroids were identified by TVUS. Their median diameter was 9.0 mm, which was significantly smaller than those of the additionally enucleated fibroids (p = 0.002). The frequency of patients with residual fibroids was calculated in relation to the number of enucleated fibroids. The results showed that the frequency tended to increase as the number of fibroids increased and that almost all the patients (7 of 8 cases, 87.5%) with > or = 10 fibroids had residual ones. The median follow-up period was 31 months (range, 6-37), and 8 cases (19.0%) had recurrent fibroids. The recurrence rate in patients with > or = 10 fibroids was 50%.


CONCLUSIONS
Intraoperative CUS was useful in detecting and enucleating residualfibroids. As the number of enucleated fibroids increased, the risk of residual fibroids and recurrence tended to increase.
Shimanuki
Hiroto
H
Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Hongo, 2-1-1, Bunkyo-ku, Tokyo, 113-8421, Japan. nucky@med.juntendo.ac.jp
Takeuchi
Hiroyuki
H
Kikuchi
Iwaho
I
Kumakiri
Jun
J
Kinoshita
Katsuyuki
K
D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007889:Leiomyoma / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D018365:Neoplasm, Residual / Q000517:prevention & control; D012307:Risk Factors; D018084:Ultrasonography, Interventional / Q000379:methods*; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*