{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T07:49:34Z","timestamp":1759564174703,"version":"3.37.3"},"reference-count":12,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2017,6,6]],"date-time":"2017-06-06T00:00:00Z","timestamp":1496707200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet & Gyne"],"published-print":{"date-parts":[[2017,8]]},"abstract":"ABSTRACT<\/jats:title>Objective<\/jats:title>In light of recent statements from the United States Food and Drug Administration warning against the use of power morcellation of uterine leiomyomas during laparoscopy, we sought to evaluate the use of preoperative two\u2010 (2D<\/jats:styled-content>) and three\u2010 (3D<\/jats:styled-content>) dimensional transvaginal ultrasound (US<\/jats:styled-content>) assessment of uterine volume to predict the need for morcellation in women undergoing laparoscopic hysterectomy (LH<\/jats:styled-content>).<\/jats:p><\/jats:sec>Methods<\/jats:title>This was a prospective observational study performed between October 2008 and November 2011 in a tertiary referral laparoscopic unit. All women scheduled to undergo LH<\/jats:styled-content> were included and underwent detailed preoperative transvaginal US<\/jats:styled-content>. Uterine volumes were calculated using 2D\u2010US<\/jats:styled-content> measurements (ellipsoid formula), and using Virtual Organ Computer\u2010aided AnaLysis<\/jats:styled-content> (VOCAL<\/jats:styled-content>\u2122) having acquired 3D\u2010US<\/jats:styled-content> volumes of the uterus. Age, parity, need to morcellate and final uterine dry weight at histology were recorded. The estimated uterine volumes were then incorporated into a previously published logistic regression model to predict the need to morcellate for both nulliparous and parous women. The probability threshold cut\u2010off of 0.14 (95% sensitivity) was evaluated in terms of sensitivity, specificity, positive predictive value (PPV<\/jats:styled-content>), negative predictive value (NPV<\/jats:styled-content>) and likelihood ratios (LRs<\/jats:styled-content>). The performance of the models incorporating 2D<\/jats:styled-content>\u2010 and 3D\u2010US<\/jats:styled-content> calculations were compared with 2D<\/jats:styled-content>\u2010 and 3D\u2010US<\/jats:styled-content>\u2010generated volumes alone, using receiver\u2013operating characteristics (ROC<\/jats:styled-content>) curves.<\/jats:p><\/jats:sec>Results<\/jats:title>Of 76 women who underwent LH<\/jats:styled-content> during the study period, 79% (n<\/jats:italic> = 60) had complete background and 3D\u2010US<\/jats:styled-content> data. Their mean age was 43.7 years, 91.7% were parous and 35% underwent morcellation. The greatest uterine volume that did not require morcellation was 404 mL<\/jats:styled-content> estimated using 3D\u2010US<\/jats:styled-content>, which corresponded to a uterine volume of 688.8 mL<\/jats:styled-content> using 2D\u2010US<\/jats:styled-content>. The smallest uterine volume that required morcellation was 118.9 mL<\/jats:styled-content> using 3D\u2010US<\/jats:styled-content>, which corresponded to a uterine volume of 123.4 mL<\/jats:styled-content> using 2D\u2010US<\/jats:styled-content>. The 3D\u2010US<\/jats:styled-content> uterine volume for parous women with a sensitivity of 95% based on ROC<\/jats:styled-content>\u2010curve analysis was approximately 120 mL<\/jats:styled-content>, which equated to a predicted probability of morcellation cut\u2010off of 0.14. For this cut\u2010off, specificity was 55.00%, PPV<\/jats:styled-content> was 51.35%, NPV<\/jats:styled-content> was 95.65%, LR<\/jats:styled-content>+ was 2.11 and LR<\/jats:styled-content>\u2013 was 0.09. Areas under the ROC<\/jats:styled-content> curves for the morcellation logistic regression model were 0.769 (95% CI<\/jats:styled-content>, 0.653\u20130.886) and 0.586 (95% CI<\/jats:styled-content>, 0.419\u20130.753) using uterine volumes obtained by 3D\u2010US<\/jats:styled-content> and by 2D\u2010US<\/jats:styled-content>, respectively, and they were 0.938 (95% CI<\/jats:styled-content>, 0.879\u20130.996) and 0.815 (95% CI<\/jats:styled-content>, 0.681\u20130.948) using 3D\u2010US<\/jats:styled-content> and 2D\u2010US<\/jats:styled-content> volumes alone.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>The need to morcellate can be predicted preoperatively using 3D\u2010US<\/jats:styled-content> uterine volumes obtained by transvaginal US<\/jats:styled-content> with a fair degree of accuracy. Uteri with volumes smaller than 120 mL<\/jats:styled-content> at 3D\u2010US<\/jats:styled-content> are very unlikely to require morcellation. The incorporation of 3D\u2010US<\/jats:styled-content>\u2010estimated uterine volume into the previously published logistic regression model does not seem to confer any significant improvement when compared with 3D\u2010US<\/jats:styled-content> uterine volume alone to predict the need to morcellate in women undergoing total LH<\/jats:styled-content>. Copyright \u00a9 2016 ISUOG. Published by John Wiley & Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.15991","type":"journal-article","created":{"date-parts":[[2016,6,9]],"date-time":"2016-06-09T16:22:45Z","timestamp":1465489365000},"page":"255-260","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Three\u2010dimensional transvaginal sonographic assessment of uterine volume as preoperative predictor of need to morcellate in women undergoing laparoscopic hysterectomy"],"prefix":"10.1002","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8559-7050","authenticated-orcid":false,"given":"B.","family":"Gerges","sequence":"first","affiliation":[{"name":"Acute Gynaecology, Early Pregnancy and Advanced Endosurgery, Sydney Medical School Nepean University of Sydney, Nepean Hospital Penrith NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Mongelli","sequence":"additional","affiliation":[{"name":"Nepean Medical School, Nepean Hospital University of Sydney, Nepean Hospital Kingswood NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I.","family":"Casikar","sequence":"additional","affiliation":[{"name":"Acute Gynaecology, Early Pregnancy and Advanced Endosurgery, Sydney Medical School Nepean University of Sydney, Nepean Hospital Penrith NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T.","family":"Bignardi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, A.O. Niguarda Ca' Granda Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G.","family":"Condous","sequence":"additional","affiliation":[{"name":"Acute Gynaecology, Early Pregnancy and Advanced Endosurgery, Sydney Medical School Nepean University of Sydney, Nepean Hospital Penrith NSW Australia"},{"name":"OMNI Gynaecological Care Centre for Women's Ultrasound and Early Pregnancy St Leonards NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,6,6]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2006.10.390"},{"issue":"5","key":"e_1_2_5_3_1","first-page":"1","article-title":"2006 National Hospital Discharge Survey","volume":"30","author":"DeFrances CJ","year":"2008","journal-title":"Natl Health Stat Report"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2014.12.002"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1479-828X.2004.00199.x"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2014.01.012"},{"key":"e_1_2_5_7_1","unstructured":"Food and Drug Administration (FDA). Laparoscopic uterine power morcellation in hysterectomy and myomectomy: FDA safety communication 2014.http:\/\/www.fda.gov\/MedicalDevices\/Safety\/AlertsandNotices\/ucm393576.htm[Accessed 23 March 2015]."},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2013.12.028"},{"key":"e_1_2_5_9_1","unstructured":"American Association of Gynecologic Laparoscopists (AAGL). 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