Evaluation of real-time imaging using a laparoscopic ultrasound probe during operative endoscopic procedures.
OBJECTIVE
To evaluate rigid and flexible ultrasound transducers introduced through a laparoscopic port to image pelvic anatomy during operative endoscopy as a means of mapping the pelvic anatomy, detecting pathology, and for real-time tracking of intra-uterine procedures.


METHODS
Prospective, descriptive, non-comparative.


METHODS
Laparoscopy, hysteroscopy and real-time, gray-scale ultrasonography were performed simultaneously in 36 patients. Laparoscopic ultrasound was performed using 10 mm diameter, 7.5 MHz gray-scale rigid and steerable transducers for imaging of the ovaries and uterus during operative endoscopy (Aloka, Wallingford, CT, USA). All patients underwent intra-operative evaluation using this probe to assess uterine and ovarian structures and to track instruments intra-operatively during complex intra-uterine hysteroscopic procedures and for intra-operative sonohysterography.


RESULTS
Laparoscopic ultrasound provided visualization of structures and delineation of ovarian anatomy needle placement for tracking microscissors and intra-operative sonohysterography. The ultrasonography provided information useful for determining the configuration of normal anatomic structures, the localization of and more precise incision placement for anatomic abnormalities and for intra-operative guidance during hysteroscopic resection of intra-uterine adhesions. The imaging also provided details of intra-uterine anatomy through sonohysterography performed during chromotubation. However, no additional information regarding ovarian or uterine abnormalities was noted beyond that detected on pre-operative transvaginal ultrasonography. No technical problems were encountered. No additional operative time was required.


CONCLUSIONS
Real-time laparoscopic ultrasound imaging is useful in monitoring complex intra-uterine operative procedures and in detailing intra-uterine anatomy during intra-operative sonohysterography. However, it did not provide more enhanced imaging of ovarian anatomy beyond images obtained with pre-operative transvaginal imaging. This imaging technique may have broad application for a variety of endoscopic operative procedures with the potential to impact on operative decision-making and requires further evaluation.
Letterie
G S
GS
Center for Fertility and Reproductive Endocrinology, Virginia Mason Medical Center, Seattle, WA 98110, USA.
Marshall
L
L
D019160:Endosonography / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D010535:Laparoscopy; D010053:Ovary / Q000000981:diagnostic imaging / Q000601:surgery; D014159:Transducers; D014599:Uterus / Q000000981:diagnostic imaging / Q000601:surgery