OP08.05: Evaluation of transvaginal ultrasound as a triage tool for planned multidisciplinary involvement in endometriosis surgery and level of hospital

To determine the effectiveness of advanced transvaginal ultrasound (TVS) to triage endometriosis surgeries to either a tertiary hospital with planned presence of multidisciplinary surgical teams (MDT) or a non-tertiary hospital. A retrospective observational study was conducted in a single tertiary unit over 10 years (2011-2020) under one advanced endoscopic gynecological surgeon. Patients with rectal endometriosis (DE) or bowel tethering with either complete or partial obliterated pouch of douglas (POD) on TVS underwent a planned joint surgery with the same advanced gynecological endoscopic surgeon and colorectal surgeon. Patients that required bowel dissection, shaving, discectomy, or segmental resection were identified. After excluding The study identified 58 patients with rectal DE or tethering with an obliterated POD on TVS who underwent a planned joint surgery with the same advanced endoscopic gynecological surgeon and a colorectal surgeon in the tertiary unit. Patients who did not have rectal DE or tethering on TVS and had a positive sliding sign were assigned to be operated at a non-tertiary hospital. 50 out of 58 (86.21%) of the above patients required either rectal shaving, discectomy or segmental resection. A further 6 patients (10.34%) needed bowel dissection with bowel conservation, leading to a total of 56 out of 68 (96.55%) with bowel handling and input by the colorectal surgeon. Only 2 out of 58 (3.45%) did not need colorectal surgeon involvement. TVS for endometriosis is a good triage tool for planning MDT involvement in endometriosis surgery and therefore determining the level of hospital to perform the operation. This will not only improve patient care by predicting planned MDT presence, but also aid in allocation of resources by allowing better utilisation of operating lists available at tertiary and non-tertiary hospitals.