title: Ultrasound is the optimal choice for guidance in difficult hysteroscopy.
abstract: OBJECTIVE
  To compare costs and complications associated with ultrasound-guided hysteroscopy vs laparoscopy-guided hysteroscopy vs hysteroscopy alone for the surgical repair of intrauterine septa and synechiae.
  
  
  METHODS
  This was a retrospective cohort study. Charts of all patients undergoing reparative surgery for intrauterine synechiae or uterine septa at our academic institution between 2000 and 2008 were reviewed. A total of 159 procedures were included in the study, categorized into concurrent laparoscopic guidance (n = 69), ultrasound guidance (n = 52) or no guidance (n = 38). Data regarding billing, surgical case logs and complications were collected for these procedures. Using these data, complication rates and inflation-adjusted charges were compared between the groups. Statistical analysis was performed using Fisher's exact test and Student's t-test, as appropriate.
  
  
  RESULTS
  A uterine perforation rate of 8.7% was observed with laparoscopic guidance vs 1.9% with ultrasound guidance (P = 0.12) and 5.3% with no guidance (P = 0.41). Analysis of billing data showed that average total costs were significantly less for ultrasound guidance than for laparoscopic guidance ($9124 vs $11 895, P < 0.001). Ultrasound guidance did not increase costs over hysteroscopy alone ($9124 vs $8242, P = 0.54).
  
  
  CONCLUSIONS
  Real-time transabdominal ultrasound guidance during the resection of intrauterine synechiae or septa resulted in a trend towards reduced uterine perforation. Moreover, ultrasound guidance is less costly than laparoscopic guidance and adds no additional cost over hysteroscopy alone. Taken together, transabdominal ultrasound guidance is the optimal means of intraoperative guidance for the resection of uterine synechiae and septa.
authors.affiliation: Division of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Kresowik
authors.forename: C H
authors.initials: CH
authors.lastname: Syrop
authors.forename: B J
authors.initials: BJ
authors.lastname: Van Voorhis
authors.forename: G L
authors.initials: GL
authors.lastname: Ryan
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006175:Gynatresia / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D015907:Hysteroscopy / Q000191:economics / Q000379:methods*; D010535:Laparoscopy / Q000191:economics; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000191:economics / Q000379:methods*; D014595:Uterine Perforation / Q000000981:diagnostic imaging* / Q000601:surgery