Follicle aspiration with interactive three-dimensional digital imaging (Voluson): a step toward real-time puncturing under three-dimensional ultrasound control

Abstract

Objective: To evaluate the possibility of performing puncturing procedures under three-dimensional ultrasound (US) control in close to real time using a new commercially available system and to describe the technique. Design: Descriptive case study. Setting: Private outpatient infertility clinic. Patient(s): A volunteer undergoing IVF-ET treatment. Intervention(s): Transvaginal needle-guided aspiration of 10 follicles using a newly developed US machine with a built-in rapid and powerful calculation software program for three-dimensional interactive volume and flow translation during operation. Interactive three-dimensional imaging was carried out during the aspiration of each follicle. Main Outcome Measure(s): The delays caused by volume acquisition and the search for the needle tip with and without “power Doppler” were estimated and compared. Result(s): Oocyte recovery was successful from all follicles. There was a mean (±SD) delay of 5.00 ± 1.22 seconds from coasting to resuming real-time US scanning during interactive volume calculation and the search for the needle tip in the three-dimensional mode. This did not delay the procedure remarkably but enabled the precise localization of both the needle and its tip after each penetration. The integration of flow signals allowed an impressive color-coded demonstration of the needle within the tissue, but the delay was significantly longer for color-coded volume acquisition (18.40 ± 4.56 seconds). Conclusion(s): Recent technology enables the performance of three-dimensional puncture procedures in close to real time; this technology is demonstrated for follicle punctures but will be of more importance in fields such as fetal medicine, oncology, and surgery.