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Ultrasound evaluation of uterine healing after laparoscopic intracapsular myomectomy: an observational study
STUDY QUESTION Can uterine scar healing after laparoscopic intracapsular myomectomy (LIM) be adequately monitored by traditional two-dimensional (2D) ultrasound (US) and Doppler velocimetry? SUMMARY ANSWER The myometrial area of the scar after LIM can be followed by 2D US and Doppler velocimetry. WH...
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| Published in: | Human reproduction (Oxford) 2012-09, Vol.27 (9), p.2664-2670 |
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| container_title | Human reproduction (Oxford) |
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| creator | Tinelli, Andrea Hurst, Bradley S. Mettler, Liselotte Tsin, Daniel A. Pellegrino, Marcello Nicolardi, Giuseppe Dell'Edera, Domenico Malvasi, Antonio |
| description | STUDY QUESTION
Can uterine scar healing after laparoscopic intracapsular myomectomy (LIM) be adequately monitored by traditional two-dimensional (2D) ultrasound (US) and Doppler velocimetry?
SUMMARY ANSWER
The myometrial area of the scar after LIM can be followed by 2D US and Doppler velocimetry.
WHAT IS KNOWN ALREADY
Apart from post-surgical adhesions, the main concern linked to laparoscopic myomectomy is the quality of healing of the myometrial incision: it has been suggested that US could be useful for assessing uterine scars after myomectomy. However, no diagnostic method has yet been widely accepted to assess the healing process.
STUDY DESIGN, SIZE, DURATION
A cohort prospective study (level of evidence II-2), run in University-affiliated hospitals: 149 women with symptomatic uterine fibroids (UFs) underwent LIM, between January 2007 and October 2011. During follow up 13 patients withdrew from the study.
PARTICIPANTS/MATERIALS, SETTING, METHODS
After LIM, all patients were followed by traditional 2D US scanning and Doppler velocimetry on Days: 0, 1, 7, 30 and 45. Authors evaluated: number, size and location of UFs, scar diameter and Doppler velocimetry and resistance index (RI) of the uterine arteries, at their ascending branch.
MAIN RESULTS AND THE ROLE OF CHANCE
The uterine examination showed a significant (P < 0.05) progressive reduction of uterine scar area from 78% of the previous UF location on the first day, to 19% on 30th day, and |
| doi_str_mv | 10.1093/humrep/des212 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1033158816</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/humrep/des212</oup_id><sourcerecordid>1033158816</sourcerecordid><originalsourceid>FETCH-LOGICAL-c461t-4241c7a3a5cfba1e7c8e6628d63656e244b00dbfd3efdd7c69cf9a9b6c29c07d3</originalsourceid><addsrcrecordid>eNqFkD1P5DAQhi0Egr2F8lrkBokm4I_Em1yHVnCHhETD1tHEHkNOThzsGGn_PYbdO0oqj6xnnpl5CfnJ2RVnjbx-SUPA6dpgFFwckAUvFSuErNghWTCh6oJzxU_Ijxj_MpbLWh2TEyFUUzeiWRC3cXOA6NNoKL6BSzD3fqTe0jRj6EekLwiuH58p2PxBHUwQfNR-6jXtx9yrYYrJQaDD1g-oZz9sf1HIii5iePvUgaNxTmZ7So4suIhn-3dJNne3T-s_xcPj7_v1zUOhS8XnohQl1yuQUGnbAceVrlEpURslVaVQlGXHmOmskWiNWWnVaNtA0yktGs1WRi7J5c47Bf-aMM7t0EeNzsGIPsWWMyl5VddcZbTYoTpfFQPadgr9AGGbofYj4HYXcLsLOPPne3XqBjT_6X-JZuBiD0DU4GyAUffxi1OiYpKprx19mr6Z-Q4fRZdb</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1033158816</pqid></control><display><type>article</type><title>Ultrasound evaluation of uterine healing after laparoscopic intracapsular myomectomy: an observational study</title><source>Oxford Journals Online</source><creator>Tinelli, Andrea ; Hurst, Bradley S. ; Mettler, Liselotte ; Tsin, Daniel A. ; Pellegrino, Marcello ; Nicolardi, Giuseppe ; Dell'Edera, Domenico ; Malvasi, Antonio</creator><creatorcontrib>Tinelli, Andrea ; Hurst, Bradley S. ; Mettler, Liselotte ; Tsin, Daniel A. ; Pellegrino, Marcello ; Nicolardi, Giuseppe ; Dell'Edera, Domenico ; Malvasi, Antonio</creatorcontrib><description>STUDY QUESTION
Can uterine scar healing after laparoscopic intracapsular myomectomy (LIM) be adequately monitored by traditional two-dimensional (2D) ultrasound (US) and Doppler velocimetry?
SUMMARY ANSWER
The myometrial area of the scar after LIM can be followed by 2D US and Doppler velocimetry.
WHAT IS KNOWN ALREADY
Apart from post-surgical adhesions, the main concern linked to laparoscopic myomectomy is the quality of healing of the myometrial incision: it has been suggested that US could be useful for assessing uterine scars after myomectomy. However, no diagnostic method has yet been widely accepted to assess the healing process.
STUDY DESIGN, SIZE, DURATION
A cohort prospective study (level of evidence II-2), run in University-affiliated hospitals: 149 women with symptomatic uterine fibroids (UFs) underwent LIM, between January 2007 and October 2011. During follow up 13 patients withdrew from the study.
PARTICIPANTS/MATERIALS, SETTING, METHODS
After LIM, all patients were followed by traditional 2D US scanning and Doppler velocimetry on Days: 0, 1, 7, 30 and 45. Authors evaluated: number, size and location of UFs, scar diameter and Doppler velocimetry and resistance index (RI) of the uterine arteries, at their ascending branch.
MAIN RESULTS AND THE ROLE OF CHANCE
The uterine examination showed a significant (P < 0.05) progressive reduction of uterine scar area from 78% of the previous UF location on the first day, to 19% on 30th day, and <4% on the 45th day. There was no correlation with the size of the fibroid or the relative reduction in the size of the scar, on both Days 1 and 45. There was a significant (P < 0.05) increase in the RI of the ipsilateral uterine arteries from 0.65 on the first post-operative day to 0.83 after 7 days followed by a decrease to 0.71 on the 30th and 0.61 on the 45th post-operative day.
LIMITATIONS, REASONS FOR CAUTION
This is a cohort investigation on a limited number of patients and it does not surgically compare LIM and ‘classic’ myomectomy in the scar US follow up.
WIDER IMPLICATIONS OF THE FINDINGS
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.
STUDY FUNDING/COMPETING INTEREST(S)
None.</description><identifier>ISSN: 0268-1161</identifier><identifier>EISSN: 1460-2350</identifier><identifier>DOI: 10.1093/humrep/des212</identifier><identifier>PMID: 22698929</identifier><identifier>CODEN: HUREEE</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Adult ; Biological and medical sciences ; Body Mass Index ; Calibration ; Cicatrix - therapy ; Cohort Studies ; Female ; Gynecology. Andrology. Obstetrics ; Humans ; Laparoscopy - methods ; Leiomyoma - complications ; Leiomyoma - pathology ; Leiomyoma - surgery ; Medical sciences ; Myometrium - diagnostic imaging ; Myometrium - surgery ; Prospective Studies ; Time Factors ; Ultrasonography, Doppler - methods ; Uterus - diagnostic imaging ; Uterus - surgery ; Wound Healing</subject><ispartof>Human reproduction (Oxford), 2012-09, Vol.27 (9), p.2664-2670</ispartof><rights>The Author 2012. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com 2012</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c461t-4241c7a3a5cfba1e7c8e6628d63656e244b00dbfd3efdd7c69cf9a9b6c29c07d3</citedby><cites>FETCH-LOGICAL-c461t-4241c7a3a5cfba1e7c8e6628d63656e244b00dbfd3efdd7c69cf9a9b6c29c07d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26250306$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22698929$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tinelli, Andrea</creatorcontrib><creatorcontrib>Hurst, Bradley S.</creatorcontrib><creatorcontrib>Mettler, Liselotte</creatorcontrib><creatorcontrib>Tsin, Daniel A.</creatorcontrib><creatorcontrib>Pellegrino, Marcello</creatorcontrib><creatorcontrib>Nicolardi, Giuseppe</creatorcontrib><creatorcontrib>Dell'Edera, Domenico</creatorcontrib><creatorcontrib>Malvasi, Antonio</creatorcontrib><title>Ultrasound evaluation of uterine healing after laparoscopic intracapsular myomectomy: an observational study</title><title>Human reproduction (Oxford)</title><addtitle>Hum Reprod</addtitle><description>STUDY QUESTION
Can uterine scar healing after laparoscopic intracapsular myomectomy (LIM) be adequately monitored by traditional two-dimensional (2D) ultrasound (US) and Doppler velocimetry?
SUMMARY ANSWER
The myometrial area of the scar after LIM can be followed by 2D US and Doppler velocimetry.
WHAT IS KNOWN ALREADY
Apart from post-surgical adhesions, the main concern linked to laparoscopic myomectomy is the quality of healing of the myometrial incision: it has been suggested that US could be useful for assessing uterine scars after myomectomy. However, no diagnostic method has yet been widely accepted to assess the healing process.
STUDY DESIGN, SIZE, DURATION
A cohort prospective study (level of evidence II-2), run in University-affiliated hospitals: 149 women with symptomatic uterine fibroids (UFs) underwent LIM, between January 2007 and October 2011. During follow up 13 patients withdrew from the study.
PARTICIPANTS/MATERIALS, SETTING, METHODS
After LIM, all patients were followed by traditional 2D US scanning and Doppler velocimetry on Days: 0, 1, 7, 30 and 45. Authors evaluated: number, size and location of UFs, scar diameter and Doppler velocimetry and resistance index (RI) of the uterine arteries, at their ascending branch.
MAIN RESULTS AND THE ROLE OF CHANCE
The uterine examination showed a significant (P < 0.05) progressive reduction of uterine scar area from 78% of the previous UF location on the first day, to 19% on 30th day, and <4% on the 45th day. There was no correlation with the size of the fibroid or the relative reduction in the size of the scar, on both Days 1 and 45. There was a significant (P < 0.05) increase in the RI of the ipsilateral uterine arteries from 0.65 on the first post-operative day to 0.83 after 7 days followed by a decrease to 0.71 on the 30th and 0.61 on the 45th post-operative day.
LIMITATIONS, REASONS FOR CAUTION
This is a cohort investigation on a limited number of patients and it does not surgically compare LIM and ‘classic’ myomectomy in the scar US follow up.
WIDER IMPLICATIONS OF THE FINDINGS
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.
STUDY FUNDING/COMPETING INTEREST(S)
None.</description><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Body Mass Index</subject><subject>Calibration</subject><subject>Cicatrix - therapy</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Gynecology. Andrology. Obstetrics</subject><subject>Humans</subject><subject>Laparoscopy - methods</subject><subject>Leiomyoma - complications</subject><subject>Leiomyoma - pathology</subject><subject>Leiomyoma - surgery</subject><subject>Medical sciences</subject><subject>Myometrium - diagnostic imaging</subject><subject>Myometrium - surgery</subject><subject>Prospective Studies</subject><subject>Time Factors</subject><subject>Ultrasonography, Doppler - methods</subject><subject>Uterus - diagnostic imaging</subject><subject>Uterus - surgery</subject><subject>Wound Healing</subject><issn>0268-1161</issn><issn>1460-2350</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><recordid>eNqFkD1P5DAQhi0Egr2F8lrkBokm4I_Em1yHVnCHhETD1tHEHkNOThzsGGn_PYbdO0oqj6xnnpl5CfnJ2RVnjbx-SUPA6dpgFFwckAUvFSuErNghWTCh6oJzxU_Ijxj_MpbLWh2TEyFUUzeiWRC3cXOA6NNoKL6BSzD3fqTe0jRj6EekLwiuH58p2PxBHUwQfNR-6jXtx9yrYYrJQaDD1g-oZz9sf1HIii5iePvUgaNxTmZ7So4suIhn-3dJNne3T-s_xcPj7_v1zUOhS8XnohQl1yuQUGnbAceVrlEpURslVaVQlGXHmOmskWiNWWnVaNtA0yktGs1WRi7J5c47Bf-aMM7t0EeNzsGIPsWWMyl5VddcZbTYoTpfFQPadgr9AGGbofYj4HYXcLsLOPPne3XqBjT_6X-JZuBiD0DU4GyAUffxi1OiYpKprx19mr6Z-Q4fRZdb</recordid><startdate>20120901</startdate><enddate>20120901</enddate><creator>Tinelli, Andrea</creator><creator>Hurst, Bradley S.</creator><creator>Mettler, Liselotte</creator><creator>Tsin, Daniel A.</creator><creator>Pellegrino, Marcello</creator><creator>Nicolardi, Giuseppe</creator><creator>Dell'Edera, Domenico</creator><creator>Malvasi, Antonio</creator><general>Oxford University Press</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20120901</creationdate><title>Ultrasound evaluation of uterine healing after laparoscopic intracapsular myomectomy: an observational study</title><author>Tinelli, Andrea ; Hurst, Bradley S. ; Mettler, Liselotte ; Tsin, Daniel A. ; Pellegrino, Marcello ; Nicolardi, Giuseppe ; Dell'Edera, Domenico ; Malvasi, Antonio</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c461t-4241c7a3a5cfba1e7c8e6628d63656e244b00dbfd3efdd7c69cf9a9b6c29c07d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Body Mass Index</topic><topic>Calibration</topic><topic>Cicatrix - therapy</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Gynecology. Andrology. Obstetrics</topic><topic>Humans</topic><topic>Laparoscopy - methods</topic><topic>Leiomyoma - complications</topic><topic>Leiomyoma - pathology</topic><topic>Leiomyoma - surgery</topic><topic>Medical sciences</topic><topic>Myometrium - diagnostic imaging</topic><topic>Myometrium - surgery</topic><topic>Prospective Studies</topic><topic>Time Factors</topic><topic>Ultrasonography, Doppler - methods</topic><topic>Uterus - diagnostic imaging</topic><topic>Uterus - surgery</topic><topic>Wound Healing</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tinelli, Andrea</creatorcontrib><creatorcontrib>Hurst, Bradley S.</creatorcontrib><creatorcontrib>Mettler, Liselotte</creatorcontrib><creatorcontrib>Tsin, Daniel A.</creatorcontrib><creatorcontrib>Pellegrino, Marcello</creatorcontrib><creatorcontrib>Nicolardi, Giuseppe</creatorcontrib><creatorcontrib>Dell'Edera, Domenico</creatorcontrib><creatorcontrib>Malvasi, Antonio</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Human reproduction (Oxford)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tinelli, Andrea</au><au>Hurst, Bradley S.</au><au>Mettler, Liselotte</au><au>Tsin, Daniel A.</au><au>Pellegrino, Marcello</au><au>Nicolardi, Giuseppe</au><au>Dell'Edera, Domenico</au><au>Malvasi, Antonio</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ultrasound evaluation of uterine healing after laparoscopic intracapsular myomectomy: an observational study</atitle><jtitle>Human reproduction (Oxford)</jtitle><addtitle>Hum Reprod</addtitle><date>2012-09-01</date><risdate>2012</risdate><volume>27</volume><issue>9</issue><spage>2664</spage><epage>2670</epage><pages>2664-2670</pages><issn>0268-1161</issn><eissn>1460-2350</eissn><coden>HUREEE</coden><abstract>STUDY QUESTION
Can uterine scar healing after laparoscopic intracapsular myomectomy (LIM) be adequately monitored by traditional two-dimensional (2D) ultrasound (US) and Doppler velocimetry?
SUMMARY ANSWER
The myometrial area of the scar after LIM can be followed by 2D US and Doppler velocimetry.
WHAT IS KNOWN ALREADY
Apart from post-surgical adhesions, the main concern linked to laparoscopic myomectomy is the quality of healing of the myometrial incision: it has been suggested that US could be useful for assessing uterine scars after myomectomy. However, no diagnostic method has yet been widely accepted to assess the healing process.
STUDY DESIGN, SIZE, DURATION
A cohort prospective study (level of evidence II-2), run in University-affiliated hospitals: 149 women with symptomatic uterine fibroids (UFs) underwent LIM, between January 2007 and October 2011. During follow up 13 patients withdrew from the study.
PARTICIPANTS/MATERIALS, SETTING, METHODS
After LIM, all patients were followed by traditional 2D US scanning and Doppler velocimetry on Days: 0, 1, 7, 30 and 45. Authors evaluated: number, size and location of UFs, scar diameter and Doppler velocimetry and resistance index (RI) of the uterine arteries, at their ascending branch.
MAIN RESULTS AND THE ROLE OF CHANCE
The uterine examination showed a significant (P < 0.05) progressive reduction of uterine scar area from 78% of the previous UF location on the first day, to 19% on 30th day, and <4% on the 45th day. There was no correlation with the size of the fibroid or the relative reduction in the size of the scar, on both Days 1 and 45. There was a significant (P < 0.05) increase in the RI of the ipsilateral uterine arteries from 0.65 on the first post-operative day to 0.83 after 7 days followed by a decrease to 0.71 on the 30th and 0.61 on the 45th post-operative day.
LIMITATIONS, REASONS FOR CAUTION
This is a cohort investigation on a limited number of patients and it does not surgically compare LIM and ‘classic’ myomectomy in the scar US follow up.
WIDER IMPLICATIONS OF THE FINDINGS
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.
STUDY FUNDING/COMPETING INTEREST(S)
None.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>22698929</pmid><doi>10.1093/humrep/des212</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
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| ispartof | Human reproduction (Oxford), 2012-09, Vol.27 (9), p.2664-2670 |
| issn | 0268-1161 1460-2350 |
| language | eng |
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| source | Oxford Journals Online |
| subjects | Adult Biological and medical sciences Body Mass Index Calibration Cicatrix - therapy Cohort Studies Female Gynecology. Andrology. Obstetrics Humans Laparoscopy - methods Leiomyoma - complications Leiomyoma - pathology Leiomyoma - surgery Medical sciences Myometrium - diagnostic imaging Myometrium - surgery Prospective Studies Time Factors Ultrasonography, Doppler - methods Uterus - diagnostic imaging Uterus - surgery Wound Healing |
| title | Ultrasound evaluation of uterine healing after laparoscopic intracapsular myomectomy: an observational study |
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