OC13.01: Ultrasonographically controlled access to peritoneal cavity in gynaecology

Ultrasonographically guided transvaginal hydrolaparoscopy (UTHL) is a new outpatient procedure which combines transvaginal hydrolaparoscopy and ultrasound imaging in pelvic examination. It provides ultrasonographically controlled access to the abdominal cavity through the posterior vaginal wall. The method is used to examine the tuboovarian complex in infertile clinic patients. The description of the method in terms of safe access to the peritoneal cavity was the aim of this study. In UTHL the pouch of Douglas (CD) is filled with saline solution via the fallopian tubes during hysteroscopy. Puncture of the CD and the insertion of the trocar with optics are done under ultrasound control (video). Single use instruments are used in UTHL. The success rate of the CD puncture and the complication rate were analyzed. Additionally, we evaluated diagnostic findings of the examination. 702 procedures were performed between 2002 and 2009. Complete evaluation of the tubo-ovarian structures was achieved in 96.2%. We detected no injury of big vessels, no infection and one bowel perforation (0.12%) in a patient with adhesions in CD. Mild adhesions were detected in 16%, 5.5% had grade I endometriosis. In 14.3% elective operative laparoscopy for tubal obstruction and/or adhesions was recommended. The postoperative stay was 2 hours. UTHL offers ultrasound guided access to peritoneal cavity. The method is used for direct visualization and evaluation of tuboovarian complex in infertile clinic patients. Single use instruments reduce markedly risk of infectious complications. The use of ultrasound enhances rapidly the safety of access to the CD. Supporting information can be found in the online version of this abstract. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.