Investigate the relationship between preoperative ultrasound uterine volume and need for morcellation at time of minimally invasive hysterectomy for fibroids.
Design:
Retrospective cross-sectional study.
Setting:
Referral academic center.
Patients or Participants:
Patients over 18 years old who underwent routine preoperative pelvic ultrasound and subsequent minimally invasive hysterectomy for fibroids between January 2020 and June 2023.
Interventions:
Electronic health record data were collected and analyzed.
Measurements and Main Results:
225 patients were included, most non-white (72.0%) and non-Hispanic/Latinx (96.0%), with mean age 45.43 years and mean BMI 33.81 kg/m2. Mean uterine volume on preoperative ultrasound was 274.48 cm3, and mean uterine volume on pathologic analysis was 452.61 cm3. 37.7% of uteri required morcellation during surgery. Larger uterine volume on ultrasound was associated with higher odds of morcellation; for a 1-cm3 increase in uterine volume, odds of morcellation increased by a factor of 1.01 (p<.001). Overall mean operative time was 176.67 minutes for non-morcellated specimens and 238.29 minutes for morcellated specimens (difference of 61.62 minutes, p<.001). This difference was 29.37 minutes when operative time was controlled for uterine volume. 79.1% of the 48 uteri with volume over 400 cm3 on preoperative ultrasound required morcellation. 85.2% of the 27 uteri over 500 cm3 and 94.7% of the 19 uteri over 600 cm3 required morcellation.
Conclusion:
Nearly 40% of patients undergoing minimally invasive hysterectomy for fibroids required uterine morcellation at time of surgery. Increased uterine volume on preoperative ultrasound conferred higher odds of requiring morcellation. Operative time increased when specimens required morcellation even when operative time was controlled for uterine volume. Preoperative uterine volume of 400 cm3 conferred an approximately 80% risk of requiring morcellation at the time of minimally invasive hysterectomy. As gynecologic surgeons tackle larger fibroid uteri with minimally invasive surgery, preoperative ultrasound estimate of uterine volume can be a helpful clinical tool to predict need for morcellation and total operative time.
Shadowen, CR*1, Kikut Caldwell, A2, Creamer, L2, Silvey, S3, Czyszczon, K1. 1Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA; 2School of Medicine, Virginia Commonwealth University, Richmond, VA; 3Biostatistics, Virginia Commonwealth University, Richmond, VA
