Laparoscopic myomectomy: Sonographic follow-up and second-look laparoscopy for the evaluation of a new technique

Evaluation of postmyomectomy uterine scar

“…In a previous study, 18 we diagnosed a definite hematoma at the site of laparoscopic myomectomy scars in 74% of our cases. 17 The hematoma persisted for 6 weeks in 8% of the cases.…”

Use of three-dimensional ultrasonography in the evaluation of uterine perfusion and healing after laparoscopic myomectomy

“…The main concern is uterine rupture during subsequent pregnancies, which has been documented in several reports (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Uterine rupture may be related to poor wound healing with poor vascularization, hematoma formation (6,19,20), and/or tissue necrosis (29). Seinera et al (23) described the normal healing pattern of a uterine scar after LM on 2D ultrasound as an echogenic, heterogeneous, and ill-defined area (23), which is similar to descriptions in previous reports (22).…”

“…In a study by Dubuisson et al (18) with the largest series of pregnancies after LM, the rate of uterine rupture attributed to LM was 1%. Uterine rupture may be related to poor wound healing with the presence of hematoma (6,19,20). It has been suggested that ultrasound could be useful for assessing uterine scars after myomectomy (20)(21)(22)(23); however, there are no published reports evaluating uterine healing after LM according to three-dimensional (3D) power Doppler ultrasound (PDU).…”

Reconstructive Endoscopic Myomectomy

“…Nevertheless, the impact of the early postoperative hematoma on wound healing is not clear so far. At 4-6 weeks postoperatively, the incidence of hematoma formation in both studies (52,53) declined markedly (8% at 6 weeks versus 7% at 4 weeks for laparoscopy and laparotomy studies respectively). Thus, the procedure should involve multilayered uterine closure to avoid hematoma formation, weaker scar and subsequent rupture.…”

“…Because hematoma formation of measurable size is not normal in wound healing, subsequent uterine rupture may be related to poor wound healing in the presence of hematoma (51). We studied 22 cases that are treated with LM followed by suturing of the incision in two or three layers trying to mimic open myomectomy (52). Moreover, we studied 169 cases treated with conventional open myomectomy with meticulous closure of the incision in multilayers (53).…”