Novel Intraoperative Transvaginal Ultrasonographic Needle Guidance in Laparoscopic Excision of Elusive Intramural Myomas: Enhancing Precision, Minimizing Hemorrhage, and Optimizing Surgical Outcomes.

Laparoscopy for intramural uterine myomas lacking serosal protrusion or hysteroscopic accessibility remains surgically challenging due to limited visualization and precise localization. This prospective case series evaluated the efficacy of intraoperative transvaginal ultrasonographic guidance in augmenting laparoscopic excision of occult intramural fibroids. Fifteen patients underwent laparoscopy with concurrent transvaginal ultrasound-guided needle localization, utilizing a 17- or 18-gauge single-lumen needle affixed to a transvaginal probe. The needle, introduced via the vaginal fornix, facilitated real-time intrauterine mapping to pinpoint myoma boundaries and optimize serosal incision placement. Complete enucleation was achieved in all cases. This technique enhanced intraoperative precision by integrating dynamic imaging to overcome visual constraints inherent in conventional laparoscopy, minimizing collateral tissue disruption and hemorrhage through targeted incision planning. The findings underscore the adjunctive role of transvaginal ultrasonography in optimizing minimally invasive myomectomy for complex intramural fibroids, offering a reproducible strategy to improve surgical accuracy, completeness of resection, and hemostatic control.