OC16.03: Pre-operative US volume evaluation of sub-mucous fibroid: a possible new way to evaluate the level of difficulty of the hysteroscopic procedure

We propose a rather new way to approach the diagnostic work-up of submucous fibroids. The objective was to evaluate if this approach offers the ability to predict whether hysteroscopic removal of a submucous fibroid would be partial or complete and to assign a level of difficulty to the procedure. A retrospective study was performed reviewing the US evaluation and respective intraoperative findings of all the 255 hysteroscopic myomectomies performed between January 2009 and January 2011 to our department. During the US evaluation, the parameters considered were: the myometrial free margin, the size of the fibroid and the percentage of the volume of the fibroid obtained by specific US procedure. The US data were compared with the operative report considered as the gold standard. We also analyzed the data based on the surgeons who performed the hysteroscopies. The surgeons demonstrated different degrees of expertise: surgeon A had the greatest skill, surgeon B intermediate skill and Surgeon C was completing his learning curve. Overall, the surgeon confirmed intraoperatively and subjectively the US evaluation in 230 cases (about 90%); of the remaining 25 cases, 10 were overestimated by US (2.5%) and 15 underestimated (5%). Of these 15 cases, 7 were respected by surgeon B and by surgeon C and the presence of surgeon A in the operating room to complete the procedure was necessary in only 2 cases. A total of 108 G2, 79 G1 and 68 G0 fibroids were respected in all. The median diameter of the fibroids was 3 cm (range 1–7 cm). We recorded 5 cases of complications (1%): 2 cases of intravasation and 3 cases of uterine perforation. All complications occurred with G2 fibroids having a diameter > 5 cm. In all 5 cases, the fibroid was not completely respected. Our data show that this new US approach correlates highly with the prediction of the respectability of myoma in a single surgical session. Moreover, it can also be used to comprehensively assess the difficulty of the procedure.