Intraoperative Transvaginal Ultrasound to Refine Surgical Strategy in Rectosigmoid Endometriosis

OBJECTIVE: To explore the role of intraoperative transvaginal ultrasound in surgical planning for deep bowel endometriosis involving the rectum, rectosigmoid junction, and inferior sigmoid colon [1]. SETTING: Pilot study in the form of a descriptive, step-by-step demonstration with narrated video content illustrating intraoperative transvaginal ultrasound to assess the extent of rectosigmoid deep endometriosis in a university hospital setting. PARTICIPANTS: Five women suspected of rectosigmoid deep endometriosis undergoing laparoscopic surgery. INTERVENTIONS: Patients underwent oral bowel preparation the day before surgery. Intraoperative transvaginal ultrasound was performed after pelvic dissection and rectal mobilization to assess the extent and depth of deep endometriosis involving the rectum, rectosigmoid junction, and inferior sigmoid colon, and to guide the surgical approach-shaving, disc excision, or colorectal resection. All scans were performed by a single gynecologist experienced in endometriosis surgery and ultrasound imaging. CONCLUSION: Intraoperative transvaginal ultrasound was feasible for evaluating deep bowel endometriosis involving the rectum, rectosigmoid junction, and inferior sigmoid colon across different surgical scenarios. The technique provided reliable information on lesion localization, size, and depth. It complemented visual and tactile intraoperative assessments, aiding in surgical decision-making. Compared to preoperative imaging, intraoperative ultrasound provides the benefit of being performed after pelvic organ mobilization, enabling a potentially more precise assessment of the lesions. This technique may help in selecting the most appropriate and least invasive bowel surgical approach, reduce the risk of residual disease, and aid in the standardization of rectosigmoid endometriosis surgery [2-5]. VIDEO ABSTRACT.