Ultrasound‐assisted laparoscopic cryomyolysis: two‐ and three‐dimensional findings before, during and after treatment

• Published in: Ultrasound in obstetrics & gynecology Vol. 25; no. 4; pp. 393 - 400
• Main Authors: Exacoustos, C., Zupi, E., Marconi, D., Romanini, M. E., Szabolcs, B., Piredda, A., Arduini, D.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.04.2005
• Subjects: Adult; Cryosurgery - methods; Female; Humans; Imaging, Three-Dimensional - methods; Laparoscopy - methods; leiomyoma; Leiomyoma - blood supply; Leiomyoma - diagnostic imaging; Leiomyoma - surgery; leiomyoma therapy; Middle Aged; Minimally Invasive Surgical Procedures - methods; Prospective Studies; Treatment Outcome; Ultrasonography, Doppler, Color - methods; ultrasound; uterine fibroid; Uterine Neoplasms - blood supply; Uterine Neoplasms - diagnostic imaging; Uterine Neoplasms - surgery
• ISSN: 0960-7692; 1469-0705
• DOI: 10.1002/uog.1861

Objective To investigate the role of two‐ and three‐dimensional (2D and 3D) ultrasound and power Doppler before, during and after surgery in monitoring the effects of uterine fibroid laparoscopic cryomyolysis. Methods This prospective study involved 10 premenopausal patients with a sonographic diagnosis of a single subserosal and/or intramural uterine myoma, who underwent laparoscopic cryomyolysis. All patients suffered from symptoms due to fibroids (menometrorrhagia, bulk‐related symptoms, pelvic pain). During laparoscopy transvaginal sonography was performed to guide the insertion of the cryoprobe, monitor extension of the iceball and evaluate the reduction of the blood supply of the myoma. All patients underwent 2D and 3D sonographic and power Doppler imaging evaluation of the myoma 1 week before treatment, during cryomyolysis, and 1, 3 and 6 months after treatment; size, echostructure and vascularization were recorded. Results With cryomyolysis, we achieved selective vessel and tissue damage within the fibroid alone. Eight patients were free of symptoms and two had improved after 3 months. Progressive shrinkage of the treated myoma was observed during follow‐up with a reduction percentage after 1 month of 22.2%, after 3 months of 37.5% and after 6 months of 52.6%. After cryomyolysis a significant reduction in central blood flow of the myoma was observed. 2D and 3D power Doppler evaluation of vascularization did not differ although subjectively findings were best evaluated by 3D images. Conclusion Sonography can aid the safe accomplishment of cryomyolysis by assessing myomata preoperatively, guiding the freezing procedure during laparoscopy, and helping to monitor postoperative progress. The use of ultrasound in this new treatment of fibroids will permit the physician to modulate and individualize treatment. Copyright © 2005 ISUOG. Published by John Wiley & Sons, Ltd.