#306 : Enhancing Myoma Detection in Robot-Assisted Myomectomy: Evaluating the Efficacy of Intracorporeal Ultrasonography

Abstract

Background and Aims: Robot-assisted myomectomy is being widely implemented in gynecologic surgery, with strength in cases with multiple myomas. To maximize myoma detection during surgery, intracorporeal ultrasonography (USG) has been introduced. The study aims to evaluate the efficacy of intracorporeal USG in robot-assisted myomectomy. Method: This was a retrospective study of patients who underwent robot-assisted myomectomy from January 2022 to February 2023. The cases with preoperative pelvis magnetic resonance imaging (MRI) and which utilized intracorporeal USG during surgery were identified. Demographic and operative variables were analyzed, along with myoma extraction rates, which were determined as the proportion of surgically removed myomas compared to the number identified in preoperative MRI, and the number of additional myomas removed during the operation. Results: In all patients, the number of myomas removed was greater than the number of myomas in preoperative MRI (12.4 ± 8.6 vs. 7.9 ± 5.0, [Formula: see text]<0.001). An average of 4.5 additional myomas were found, and the extraction rate was 167%. For subgroup analysis, patients were stratified according to preoperative myoma counts: 1-5(n=22), 6-9(n=17), and 10 or more(n=17). For all three groups, more myomas were detected in surgery with the use of intracorporeal USG (Median 4 vs 5, [Formula: see text]=0.001, 7 vs 12, [Formula: see text]<0.001, 12 vs 18, [Formula: see text]=0.005, respectively) and the number of additional myomas removed increased in proportion to the preoperative myoma count. There was a positive correlation between the number of myomas identified in preoperative MRI and the number of additional myomas removed (Pearson’s correlation coefficient: 0.292, p=0.029). Conclusion: Intracorporeal ultrasound improves myoma detection, as significantly more myomas are removed during surgery than anticipated based on preoperative MRI. Moreover, this study demonstrates a positive correlation between the number of myomas identified in preoperative MRI and the additional myomas removed during surgery. Intracorporeal ultrasound may be particularly advantageous for patients with multiple myomas detected on preoperative MRI.