OC073: What a surgeon needs to know from ultrasound before operating on the uterus

uterine fibroids and bleeding disturbances; uterine anomalies; uterine magnacies. Ultrasound investigation prior to endoscopic surgery. In hysteroscopic surgery, preoperative selection of suitable cases with TVS can improve the success rate of transcervical resection of fibroids even further, and thereby avoid additional surgery. Parameters need to be assessed: The anterior/posterior (AP) diameter: Smaller transverse and AP diameters of the uterus appear to predict a more successful outcome. During surgery, problems with deficit of irrigation solution were more pronounced in patients with AP diameter of > 55 mm. Maximum endometrial thickness (ET): An ET of < 8.3 mm predicts well post endometrial resection amenorrhoea in one year follow up. Adenomyosis (salt and pepper look in the myometrium): better treated with a subtotal hysterectomy. The extent and invasion of the neoplasm in endometrial cancer indicate in which cases lymphadenectomy should be performed. A classification system for submucous fibroids on TVS has been developed. Pedunculated submucous fibroids without intramural extension are classified as type 0 fibroids. Type I is when the submucous fibroids is sessile and the intramural part is less than 50%, with an intramural extension of 50% or more, the fibroid is classified as type II. The hysteroscopic approach to type I and II fibroids is different compared to type 0, as the former often require a two-step operation. That helps the surgeon to obtain full informed consent from the patient and warn about the risks. In type II fibroids, the decision of hysteroscopic or laparoscopic approach (whether suturing is needed) is dependent on ultrasound as well. In congenital anomalies, TVU is important to determine whether a hysteroscopic or laparoscopic or combined approach might be needed. Ultrasound investigation is mandatory in order to determine and carefully plan the operative endoscopic approach.