Ultrasound guidance during endoscopic procedures

The use of laparoscopic ultrasound probes has been shown to improve outcomes and facilitate surgery for hepatobiliary and pancreatic cancers. It is a useful, inexpensive, and safe imaging technique that should also supplement operative laparoscopy for gynecologic indications. These techniques are new, and their use in gynecologic surgery has not been adequately evaluated to recommend widespread use. The principal benefit of ultrasound monitoring during operative laparoscopy is its potential impact on operative management and decision making. Theoretically, the intentions would be to reduce the amount of tissue dissection, for example, by more precisely locating an ovarian endometrioma; to reduce operating time; and to monitor more closely intrauterine procedures. Further prospective randomized studies are needed to define the exact role of ultrasound monitoring in gynecologic surgery. An exciting possibility is its use to define intraovarian anatomy more definitively in the hope of minimizing the amount of ovarian dissection and, in select circumstances, guiding further intrauterine surgery. With the use of steerable probes, an assessment could be made of the pelvic side wall in oncologic surgery to select specifically nodes that are highly suspicious for malignancies, thereby minimizing the amount of dissection necessary in staging procedures. Intraoperative ultrasound guidance in intrauterine endoscopic procedures offers a noninvasive means of assessing the precision of such procedures and provides information regarding the exact location of instruments within the uterine cavity and uterine wall. It has been used for almost 15 years, and adequate clinical experience has been accrued. It offers an alternative to more invasive laparoscopy and may be considered as an adjunct to any complicated intrauterine procedure.