Uterine applications of the laparoscopic ultrasound

To demonstrate the use and setup of a laparoscopic ultrasound (LUS), and show its application during a myomectomy.

A surgical case and accompanying literature are reviewed to demonstrate the features of the LUS, set up of the LUS, and its use during a myomectomy.

The patient included in this video gave consent for publication of the video and posting of the video online including social media, the journal website, scientific literature websites (such as PubMed, ScienceDirect, Scopus, and so forth), and other applicable sites. Our patient was diagnosed with a multifibroid uterus, and had failed medical management. The surgery occurred in an elective outpatient operating room.

A robotic myomectomy with LUS is demonstrated, along with the use and set up of LUS.

Number of fibroids resected at the time of myomectomy.

Laparoscopic ultrasound using a 5-10 MHz transducer delivered real-time, high-resolution imaging directly on uterine tissue, eliminating acoustic artifacts and overcoming reduced tactile feedback in minimally-invasive surgery. As demonstrated in prospective literature, LUS detects a median of two additional fibroids per patient, predominantly FIGO Types 2 and 3, compared with preoperative imaging. In the featured case, LUS was used in a 38-year-old woman with infertility and recurrent symptomatic fibroids. Preoperative transvaginal ultrasound (TVUS) identified three fibroids, dominated by a 9.8 cm posterofundal intramural lesion. Intraoperatively, the three reported fibroids were found easily. Systematic LUS use revealed two additional deep intramural fibroids missed on TVUS: a bilobed anterior wall fibroid and a distinct left anterior/lateral fibroid. Targeted extension of hysterotomies enabled complete enucleation of these fibroids while preserving healthy myometrium.

This case demonstrates how LUS helps overcome TVUS limitations by identifying hidden intramural fibroids, optimizing surgical incisions, and facilitating complete anatomical restoration for fertility preservation.