OC131: Selecting women with pelvic pain for laparoscopic intervention

Surgical intervention has advanced with the development of minimal access surgical techniques for use in the office and on a day surgical basis to manage women with pelvic pain. 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 laparoscopy in women with pelvic pain. The two techniques dovetail with each other. In women with chronic pelvic pain, TVS can diagnose hard markers such as an endometrioma, pelvic adhesions or hydrosalpinges with confidence. This allows the selection of patients for operative laparoscopy. In the absence of hard markers, indirect soft markers such as ovarian mobility and site-specific tenderness can be used to predict the likelihood of the presence or absence of pelvic pathology at laparoscopy. The majority of patients without hard or soft markers will have a normal pelvic at laparoscopy. In the acute gynaecological setting, common pathology such as ovarian cysts and tubo-ovarian abscess can also be diagnosed with confidence. A normal scan has a high negative predictive value for significant pelvic pathology, thus making laparoscopy unnecessary and allowing outpatient treatment and follow up. TVS can be used to triage patients with acute and chronic pelvic pain into those that require surgical intervention, conservative or medical management.