VP05.18: Intraoperative transvaginal sonography for endometriosis surgery

We will demonstrate that with intraoperative transvaginal ultrasound (iTVS), it is possible to identify the posterior compartment structures, special attention to the uterosacral ligaments and the pouch of Douglas (POD) peritoneum. This technique could be applied to increase the likelihood of detecting subtle endometriotic lesions and optimising excision, and improving the surgeon-sonologists trainees` learning curve's quality and confidence. During laparoscopy surgery on which the pouch of Douglas was filled with 2 litres of normal saline to make an acoustic window for better ultrasonic visualisation. It was possible to visualise the same structure through laparoscopic and sonography view utilising laparoscopic atraumatic forceps grasping the uterosacral ligament. In patients in whom recurrences of endometriosis lesions are found, the doubts remain whether they are endometriotic lesions that recurred or if they are not perceived and removed surgically in the first approach. Considering the latter hypothesis, all viable options that could reduce the risk of leaving endometriosis lesions untreated during surgery may be welcome and contribute to reducing future lesions and clinical symptoms. We propose that intraoperative TVS may be useful and feasible especially to confirm anatomic regions previously identified through pre-operative ultrasound and reassure the ultrasonographic technique to find them. To locate intraoperatively endometriotic lesions not identified on the primary laparoscopic view, enhancing the chances of a full excision and probably reducing recurrence risks. 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.