OP17.05: Comparison of the number of uterine myomas detected by transvaginal ultrasonography and removed by laparotomic myomectomy

To assess the ability to detect the number of uterine myomas by transvaginal ultrasonography (TVS) supporting clinical examination performed in an authentic community setting. A retrospective comparison of the number of myomas revealed by preoperative TVS and documented after laparotomic myomectomy was conducted in 110 premenopausal consecutive patients referred for surgery. TVS performed by various experienced operators were intentionally included in order to create a group of subjects representative of a realistic community environment. The number of myomas identified by TVS and the number of myomas removed during surgery corresponded in 63 cases (57.3%). In the subgroup of 88 patients with a preoperative diagnosis of three or fewer myomas TVS missed at least one myoma in 31 (35.2%) cases. Among the 72 women diagnosed with one myoma at preoperative TVS, 19 (26.4%) actually had two or more myomas at the end of surgery. TVS supporting pelvic examination reinforces the clinical diagnosis of uterine myomas but it often fails to ascertain their number, resulting in a poor preoperative characterization of patients. The fact that one myoma may be overlooked in one third of patients theoretically eligible for laparoscopic conservative surgery may motivate the implementation of ultrasound diagnosis through skilled specialists with proper equipment when laparoscopic myomectomy is considered.