Ultrasound evaluation of uterine healing after laparoscopic intracapsular myomectomy: an observational study

Abstract

LIM avoided intraoperative bleeding and excessive tissue damage, as post-operative US follow up showed, with just two intra-myometrial hematomas (1.5%). The 2D US and Doppler velocimetry, a non-invasive safe method to check the myometrium after LIM, can detect post-operative hematoma and disechogenic, heterogeneous or ill-defined scar area, all unfavorable signs for myometrial scarring. Moreover, Doppler transvaginal monitoring, evaluating the pulsatility index (PI) and RI of the uterine arteries at their ascending branch, could identify patients with altered PI and RI parameters, possible markers of impaired wound healing.

A multicenter study comparing surgical outcomes and ultrasonographic evaluation of scarring after laparoscopic myomectomy with conventional versus barbed sutures

“…The two positive effects of CBS could be related to the knotless technique, which eliminates the need for knots and tightening. Laparoscopic myomectomy is considered to be technically challenging by many gynecologic surgeons, and the ability to perform quick and safe suturing is probably the main technical limit [18,19,21]. CBS intuitively makes the procedure easier and shortens the learning curve by comparison with TIS.…”

“…The uterine scar diameter and healing pattern were determined by placing calipers around the outer edge of the echogenic, heterogeneous, and ill‐defined areas [18]. For evaluation, each myometrial scar diameter was compared with the maximal myometrial diameter of the area previously occupied by the uterine fibroid before surgery [18]. For women with multiple myomas, each tumor was considered individually.…”

“…All patients underwent transvaginal ultrasonography by a physician on days 1, 60, and 90 after surgery to evaluate the number, size, and location of scars in the uterine area. The uterine scar diameter and healing pattern were determined by placing calipers around the outer edge of the echogenic, heterogeneous, and ill‐defined areas [18]. For evaluation, each myometrial scar diameter was compared with the maximal myometrial diameter of the area previously occupied by the uterine fibroid before surgery [18].…”

“…However, laparoscopic myomectomy is considered to be a fairly difficult procedure [3,4]: major concerns include the surgeon's wall‐reconstruction and suturing skills [7–9], reproductive outcomes [10–13], risk of recurrence [14–16], and costs, operative time, and risk of conversion to laparotomy [14–16]. The ability to perform a quick and safe laparoscopic suture is therefore essential [17–19].…”

Uterine rupture and placenta accreta spectrum following laparoscopic myomectomy in Japan: A message from obstetricians to gynecologic laparoscopists

“…It is important, particularly for beginners, to familiarize themselves with the features of surgical devices and the methods of using them, in addition to enhancing their surgical skill levels, before using the devices. In some reports, hematoma in the uterine muscle layer developed after myomectomy in 1.5 % to 4.4 % of cases, [38][39][40] and intramural hematoma was also observed by ultrasonography in 74% of cases immediately after myomectomy. 41) Thus, it may be necessary even for skilled surgeons to train constantly in order to maintain as well as improve their suturing skills.…”