Intraoperative three-dimensional sonohysterography: a new technique to monitor hysteroscopic metroplasty

Abstract

OBJECTIVE: To illustrate the utility of a new technique, intraoperative tridimensional (3D) sonohisterography, to monitor non invasively the surgical correction of uterine anomalies. DESIGN: Prospective evaluation of infertility patients undergoing hysteroscopic correction of uterine anomalies in a single private infertility clinic between October 2009 and April 2010. MATERIALS AND METHODS: Twenty infertility patients with septate, subsebtate or arcuate uteri underwent operative hysteroscopy with a Wolf 5 mm compact hysteroscope using cold scissors. Intraoperatively, a voluson i was used to guide the surgery transabdominally with a 3D RAB 4-8 probe. Moreover, a 3D transvaginal RIC 5-9 probe was used to acquire an uterine volume with the hysteroscope in place and monitor the progress of the operation. The result is an intraoperative sonohisterography, which allows precise evaluation of the uterine cavity (mirrowing the histeroscopic view) as well as the external contour of the uterus. RESULTS: In all cases the volumes acquired intraoperatively, which are identical to those obtained when performing 3D sonohisterography, illustrate perfectly the progress of the operation indicating when the surgical procedure is complete and thus minimizing the risk of uterine perforation. CONCLUSION: Three-dimensional ultrasound, both transabdominal and transvaginal, can be used successfully to monitor the progress of hysteroscopic metroplasty, obviating the use of the more invasive, traditionally used laparoscopy. Transvaginal intraoperative 3D sonohisterography is a quick and extremely precise technique.