Duan Li MD, Presenter: Nothing to Disclose

Debra M. Sarasohn MD, Abstract Co-Author: Nothing to Disclose

Ariadne Maria Bach MD, Abstract Co-Author: Nothing to Disclose

This study evaluates the effectiveness of intraoperative ultrasound guidance in certain gynecologic procedures among high risk patients.

A retrospective analysis of data collected from a tertiary cancer center was performed. A total of 101 consecutive patients who underwent gynecologic procedures with intraoperative ultrasound guidance from 1999 to 2013 were included. The procedures include D&C, polypectomy, cone biopsy, IUD retrieval, and placement of intracavitary brachytherapy seeds. All intraoperative ultrasound exams were correlated with surgical pathology results. The following information was assessed: successful access to the endometrial cavity, adequate tissue sampling, and complications including bleeding and perforation.  

Of 101 patients who underwent gynecologic procedures in the operating room with intraoperative ultrasound guidance, 75 patients previously had unsuccessful procedures in clinic. The failure in clinic was due to significant cervical stenosis caused by either trachelectomy for cervical cancer or pelvic radiation therapy for anal cancer. Among these 75 patients, 12 were diagnosed with endometrial polyps on imaging prior to the OR procedure. Of the 26 patients who went directly to the operating room, eight patients had GTD with increased HCG levels; six had partial or complete molar pregnancies; six required placement of intracavitary brachytherapy seeds; three had bicornuate uterus; two had IUDs in place for more than 40 years (in one of these two patients, the IUD device had deeply penetrated into the myometrium); and in one patient minimal cervical tissue remained after cone biopsy in clinic, making image-guided cervical tissue sampling essential to avoid perforation. In five of the 101 cases, intraoperative ultrasound guidance failed to provide access to the endometrial cavity. The overall success rate was thus 95%. In two cases, the peritoneal cavity was penetrated. However, in no cases was the uterus perforated.  

The use of intraoperative ultrasound guidance for certain gynecologic procedures in high risk patients can increase the success rate of accessing the endometrial cavity and decrease complications.

provide intraoperatived image guidance for gynecologic surgeon in high risk patients

Li, D, Sarasohn, D, Bach, A, Effectiveness of Intraoperative Ultrasound Guidance in Certain Gynecologic Procedures in High Risk Patients.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14011616.html