Diagnostic Accuracy of Transvaginal Ultrasound for Detecting Pelvic Adhesions and Predicting Surgical Time in Benign Gynecologic Surgery

OBJECTIVES: To assess the diagnostic accuracy of transvaginal ultrasound using the sliding sign for detecting pelvic adhesions and its correlation with operative time in laparoscopic surgery for benign gynecologic conditions. METHODS: A prospective, blinded diagnostic accuracy study was performed at Hospital San Juan de Dios, Santiago, Chile, from February 2022 to September 2023. Patients scheduled for benign laparoscopic surgery underwent preoperative transvaginal ultrasound within 30 days. Retrocervical and high sliding signs, adnexal mobility, and peritoneal pseudocysts were evaluated. Laparoscopic findings were the reference standard. Diagnostic accuracy and operative times were analyzed. RESULTS: A total of 202 patients were included (mean age 36 years). Pelvic adhesions were identified intraoperatively in 63 patients (31.2%), mainly loose adhesions (28.7%). The retrocervical sliding sign showed the best performance for Pouch of Douglas (POD) obliteration (sensitivity 65%, specificity 96%, accuracy 93.5%). Adnexal mobility tests had moderate sensitivity (53-64%) but high specificity (>90%). The high sliding sign was poorly sensitive (16%) but high specificity (95%). Negative sliding signs were associated with longer operative time (139 versus 60 minutes; p < .01). Obliteration of the POD was strongly linked to chronic pelvic pain, infertility, and deep infiltrating endometriosis (p < .01). A history of laparotomy was a significant risk factor for adhesions (38.3% versus 13.6%; p < .001). CONCLUSION: Transvaginal ultrasound, particularly the sliding sign, is a reliable tool for excluding pelvic adhesions. Its high specificity and negative predictive value support its routine use in preoperative evaluation and surgical planning for benign gynecologic procedures.