Standardization of laparoscopic pelvic examination: a proposal of a novel system.
Objective. Laparoscopic pelvic assessment is often performed in a nonstandardized fashion depending on the surgeon's discretion. Reporting anatomic findings is inconsistent and lesions in atypical locations may be missed. We propose a method for systematic pelvic assessment based on anatomical landmarks. Design. Retrospective analysis. Setting. Tertiary care academic medical center. Intervention. We applied this system to operative reports of 540 patients who underwent diagnostic or operative laparoscopy for unexplained infertility between 2006 and 2012. The pelvis was divided into 2 midline zones (zone I and II) and right and left lateral zones (zone III and IV). All reports were evaluated for the comprehensiveness of description with respect to normal findings or pathology for each zone. Results. Of 540 surgeries, all reports commented on the uterus, tubes, and ovaries (100%), but only 17% (n = 93, 95% CI: 13.8-20.2) commented on the dome of the bladder and the anterior cul-de-sac. 24% (n = 130, 95% CI: 20.4-27.6) commented on the posterior cul-de-sac, and 5% (n = 29, 95% CI: 3.2-6.8) commented on the pelvic sidewall. Overall, 6% (n = 34, 95% CI: 4-8) reported near complete documentation of the pelvic zones. Conclusion. Implementation of a systematic approach for laparoscopic pelvic examination will enhance the diagnostic accuracy and provide better communication between care providers. In the absence of pelvic pathology, we recommend a minimum of 6 photographs of the 6 pelvic zones.
Department of Gynecology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA ; Division of Reproductive Endocrinology and Infertility, Department of OB/GYN, University of British Columbia, D415A, Shaughnessy Building-4500 Oak Street, Vancouver, BC, Canada V6H 3N1.
Mohamed A
MA
Bedaiwy
Department of Gynecology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA.
Rachel
R
Pope
Department of Gynecology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA.
Drisana
D
Henry
Department of Gynecology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA.
Kristin
K
Zanotti
Department of Gynecology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA.
Sangeeta
S
Mahajan
Department of Gynecology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA.
William
W
Hurd
Department of OB/GYN and Women's Health Institute, Cleveland Clinic, Cleveland, OH 44106, USA.
Tommaso
T
Falcone
Department of Gynecology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA.
James
J
Liu