Intrauterine interventions with the aid of ultrasonography

Abstract

Aim: The aim of this study was to research the applicability of the surgical treatment of intrauterine pathologies with the aid of ultrasonography by passing a laparoscopic grasper or scissor through a metal sheath placed in the cervical canal, and compare this method with hysteroscopy, which is considered the gold standard in diagnosis and treatment.Methods: Our study was conducted with 39 cases where intrauterine pathologies were found with transvaginal ultrasonography (TVUSG). The patients were evaluated for endometrial polyp, submucosal leiomyoma/fibroid and uterine malformations using a transvaginal probe in the 6th to 12th days of the menstrual cycle. Patients with endometrial polyps and submucosal leiomyomas/fibroids were excised with a laparoscopic 5 mm grasper. A laparoscopic plain dissection scissor (5 mm) was used instead of a grasper for the uterine septum. In patients undergoing polypectomy and myomectomy, the uterine cavity was reevaluated by TVUSG about one month later (in the follicular phase after the first menstruation). Patients who underwent resection of the septum after the second menstrual bleeding, intrauterine cavity and tubal were evaluated by hysterosalpingography.Results: Considering the presence of intrauterine pathologies, TUSVG has sensitivity of 1 (0.87- 1.0), specificity of 0.56 (0.21-0.86), positive predictive value of 0.87 (0.71-0.96), negative predictive value of 1 (0.48-1.0), accuracy of 0.89 and positive likelihood ratio of 2.25 (1.03-4.5) for the detection endometrial polyps. When endometrial polyps were found as the intrauterine pathology during TUSVG, the chance of having endometrial polyps in hysteroscopic diagnosis was found to be 2.25 times more compared to those with no pathology. According to hysteroscopic diagnosis, TUSVG has sensitivity of 0.90 (0.74-0.98), specificity of 0.56 (0.21-0.86), positive predictive value of 0.87 (0.71-0.96), negative predictive value of 0.63 (0.25-0.92), accuracy of 0.82 and positive likelihood ratio of 2.03 (0.95-4.2) for intrauterine pathology. When the intrauterine pathology was found during TVUSG, the chance of having these pathologies in hysteroscopic diagnosis was found to be 2.03 times more compared to those with no pathology.Conclusion: We think that the surgical treatment of intrauterine pathologies with the aid of ultrasonography can be an alternative for hysteroscopy.