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

Objective: To evaluate vascular perfusion and uterine healing after laparoscopic myomectomy using three-dimensional power Doppler ultrasound (3D-PDU). Design: Prospective study. Setting: University-affiliated hospital. Patient(s): Ninety-seven women with symptomatic myomas warranting laparoscopic myomectomy. Intervention(s): Three-dimensional PDU obtained preoperatively and 1 week and 3 months postoperatively. Main Outcome Measure(s): Resistance index, pulsatility index, and peak systolic velocity of the uterine artery; vascularization index, flow index, and vascularization flow index of the uterine tissue, nonoperative area, and healing myometrial area. Result(s): The median age was 39 years. More than half of the patients were nulliparous, and one third desired fertility. The median myoma size was 8 cm, and median weight of the extirpated myomas was 250 g. The median myoma volume was 262 cm(3), and median uterine volume was 380 cm(3). On the 7th postoperative day all laparoscopic myomectomy healing sites appeared as highly echogenic areas with profuse blood flow at the periphery and reduced resistance index and pulsatility, index of the uterine artery. Nonoperated areas had significantly more blood flow than healing areas. Two patients had hematomas, which appeared as hypoechoic areas that were almost avascular. By the 3rd postoperative month the blood flow and uterine volume decreased significantly. However, an 11-cm(3) hypoechoic hematoma with poor tissue perfusion was still seen in 1 patient with a 720-cm(3) myoma. Conclusion(s): Healing of a laparoscopic myomectomy scar can be evaluated by 3D-PDU. Adequate perfusion demonstrated by 3D-PDU might suggest good wound healing and dissolving of hematomas. (Fertil Steril (R) 2009;92:1110-5. (C)2009 by American Society for Reproductive Medicine.)