Alterations in endometrial vascular density via hysteroscopy evaluated by vascular analysis software during laparoscopic myomectomy on an infertile woman with submucous myoma.

Abstract

Submucous myomas cause infertility and recurrent pregnancy loss. Several studies have reported successful reproductive outcomes after hysteroscopic myomectomy (HM), but the risk of postoperative intrauterine adhesion is present. We performed laparoscopic myomectomy (LM) for a submucous myoma and second look laparoscopy under observation using a hysteroscope to evaluate the alteration in endometrial vascular density during surgery using vascular analysis software. The patient was a 33-year-old nulliparous infertile woman. She had one submucous myoma of 4 cm in diameter and 50-60% penetration into the myometrium (class T:II; the European Society of Hysteroscopy classification). The surface vascular density of the submucous myoma was 68.6% before the start of surgery, decreased to 51.4% upon vasopressin injection and increased to 67.6% at the end of LM. Intraabdominal and intrauterine adhesions were not seen at second look laparoscopy. The vascular density was 70.8%, and the rate of endometrial blood flow was increased to 112.5% by comparison with the vascular density before the start of surgery. HM is a safe and effective procedure, but carries the risk of scarring the uterine cavity with uterine adhesions. We have to consider LM for women of reproductive age who have a submucous myoma with penetration >50% into the myometrium (class T:II).

• Authors: Keiji Kuroda, Mari Kitade, Iwaho Kikuchi, Jun Kumakiri, Shozo Matsuoka, Masako Kuroda, Satoru Takeda
• Journal: Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy (Minim Invasive Ther Allied Technol) Vol. 20 Issue 1 Pg. 58-61 (Jan 2011) ISSN: 1365-2931 [Electronic] England
• PMID: 21155634 (Publication Type: Case Reports, Journal Article)

Topics

• Adult
• Diagnosis, Computer-Assisted
• Endometrium (blood supply)
• Female
• Humans
• Hysteroscopy (adverse effects, methods)
• Infertility, Female (surgery)
• Laparoscopy (methods)
• Leiomyoma (surgery)
• Postoperative Complications
• Software
• Tissue Adhesions (etiology)
• Uterine Diseases (etiology)