OC159: Reducing surgical intervention with transvaginal ultrasound

Surgical intervention has advanced with the development of minimal access surgical techniques for use in the office and on an outpatient basis to manage common gynaecological conditions. Transvaginal ultrasound (TVS) has had a major impact on many areas of gynaecological practice, and in particular as the investigative tool of choice prior to surgery. The two techniques dovetail with each other. In postmenopausal women, an endometrial thickness (ET) of < 4 mm is associated with atrophy. In premenopausal women, hydrosonography (HS) helps to delineate focal pathology such as endometrial polyps and submucous fibroids. This obviates the need for diagnostic hysteroscopy, allowing patient selection for hysteroscopic surgery or open procedures. The majority of ovarian masses are transient and do not require surgical intervention. Persistent benign ovarian masses can now be accurately characterised and triaged to appropriate surgery. Persistent suspicious ovarian masses should be surgically explored. 80% of women with chronic pelvic pain in the absence of any hard markers (e.g. endometrioma, adhesions) and with freely mobile pelvic organs and no pelvic tenderness will have a normal pelvis and so laparoscopy can be avoided. In the acute gynaecological setting, a normal scan has a high negative predictive value for significant pelvic pathology allowing outpatient treatment and follow up. TVS plays a pivotal role in the assessment of early pregnancy complications. Early fetal demise diagnosed on TVS can be managed expectantly of medically. An ectopic pregnancy can be visualised on TVS in > 90% of cases, making medical and expectant management possible without the need for surgical intervention. A good quality scan can often demonstrate that surgery is not necessary, while it is possible to select those cases that are suitable for laparoscopic, hysteroscopic or open surgical procedures.