P-303 Value of ultrasound-based endometriosis staging system in anticipating complexity of laparoscopic surgery

Abstract Study question Does the preoperative ultrasound-based endometriosis staging system (UBESS) have the effectiveness in anticipating the complexity of laparoscopic surgery for optimal patient counseling and treatment ? Summary answer UBESS serves as an efficient tool for estimating severity of endometriosis and predicting complexity level of laparoscopic surgery based on the RANZCOG/AGES surgical skill levels. What is known already There is no comprehensive system available to assess endometriosis severity before surgery. . Ultrasound-based endometriosis staging system(UBESS) has been introduced to classify disease severity before surgery .On the basis of the Royal Australian and New Zealand College of Obstetricians and Gynecologists/Australasian Gynecological Endoscopy and Surgery(RANZCOG/AGES) , it has been shown to have a good accuracy in anticipating the difficulty of laparoscopic surgery . The subgroup of moderate to severe stages has been small in existing studies. we evaluated UBESS performance in anticipating the complexity level of laparoscopic surgery based on the RANZCOG/AGES , in advanced stages of the disease . Study design, size, duration A prospective observational cohort study involved 157 women suspected of endometriosis who underwent transvaginal ultrasound before surgery and laparoscopic endometriosis-related operations at a University affiliated hospital , from June 2019 to May 2023. Participants/materials, setting, methods A total of 157 women presenting with chronic pelvic pain and/or a history of endometriosis underwent laparoscopic surgery. Eligible women underwent transvaginal ultrasound before laparoscopic surgery. The UBESS staging was conducted based on ultrasound results. The necessary surgical skill levels were assessed, during the laparoscopic procedure, using (RANZCOG/AGES) system. The study evaluated the correlation between the three UBESS stages and the six RANZCOG/AGES laparoscopic skill levels. Main results and the role of chance The primary objective was how accurately the UBESS predicts the complexity of endometriosis laparoscopic surgery. The UBESS staging system classified nine patients (5.9%) as UBESS I, 61 patients (40.1%) as UBESS II, and 82 patients(53.9%) as UBESS III. The accuracy, sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of the UBESS I for anticipating RANZCOG/AGES levels 1/2 were: 99.3%, 90%, 100%, 100%, 99.3%, not applicable, and 0.1%. For UBESS II to anticipate RANZCOG/AGES levels 3/4 were 96.7%, 95.1%, 97.7%, 96.7%, 96.7%, 0.92, and 0.04, and for UBESS III to anticipate RANZCOG/AGES level 6 were 97.3%, 98.7%, 95.8%, 96.3%, 98.5%, 0.94, and 0.01, respectively. Ultrasound-based endometriosis staging system was highly accurate in anticipating the complexity of laparoscopic surgery based on RANZCOG/AGES laparoscopic skill levels, with an overall accuracy of 96.7% and a Cohen’s kappa value of 0.94, which implies an approximately complete level of agreement. Considering the significant number of UBESS II and UBESS III patients and their high accuracy, sensitivity, and specificity, this staging system is an effective tool for predicting moderate-to-severe endometriosis Limitations, reasons for caution One significant limitation is the inability to conduct all surgical procedures by a single surgeon, which may lead to interobserver variability in the assessment of endometriosis severity and in determining the required level of surgical skills. Wider implications of the findings not applicable Trial registration number No