Objective: D&C, first described by Recomier in 1843, was the original mainstay for diagnosis and treatment of endometrial pathology. U/S is a noninvasive imaging modality that has revolutionized gynecologic practice. Hysteroscopy enables direct vision of the endometrial cavity for diagnosis and, with special instrumentation, intrauterine surgery. Still, many procedures are done blindly. Operators have described concomitant use of transabdominal U/S; however, the vaginal probe offers better image quality. This report is the first description of a device that allows simultaneous transvaginal U/S imaging during intrauterine surgical procedures.Methods: A specially designed vaginal speculum leaves ample room anteriorly for the imaging apparatus. A special tenaculum with the ratchet and handle at 90° to its usual location is applied to the cervix in the routine fashion. An adaptor surrounds the vaginal transducer, is snapped securely in place, and then mates the vaginal probe in a long axis projection. As the tenaculum is moved, the vaginal probe moves in tandem with it. The operator then conducts the surgical procedure in the usual fashion. The sonographic field of view shows continuous real-time images of the uterus during all stages of the surgical procedure. 28 procedures were performed.Results: There were 25 terminations of pregnancy between 7 and 24 weeks, one molar pregnancy evacuated, one endometrial polyp removed hysteroscopically, and one submucous resection of a myoma. The procedures were captured on video. In all cases, various surgical instruments were continually seen in real time. No intraoperative complications occurred.Conclusions: Transabdominal ultrasound requires an additional person, not involved in the surgical procedure, to operate the equipment. This TUAGS system allows a single individual to control the U/S while performing the surgical procedure. One hand holds the tenaculum, in this case tethered to the U/S probe, while the other hand can dilate or curette or resect in the usual fashion. Such continuous visualization can shorten operative time and increase safety, although further studies will be necessary. Objective: D&C, first described by Recomier in 1843, was the original mainstay for diagnosis and treatment of endometrial pathology. U/S is a noninvasive imaging modality that has revolutionized gynecologic practice. Hysteroscopy enables direct vision of the endometrial cavity for diagnosis and, with special instrumentation, intrauterine surgery. Still, many procedures are done blindly. Operators have described concomitant use of transabdominal U/S; however, the vaginal probe offers better image quality. This report is the first description of a device that allows simultaneous transvaginal U/S imaging during intrauterine surgical procedures. Methods: A specially designed vaginal speculum leaves ample room anteriorly for the imaging apparatus. A special tenaculum with the ratchet and handle at 90° to its usual location is applied to the cervix in the routine fashion. An adaptor surrounds the vaginal transducer, is snapped securely in place, and then mates the vaginal probe in a long axis projection. As the tenaculum is moved, the vaginal probe moves in tandem with it. The operator then conducts the surgical procedure in the usual fashion. The sonographic field of view shows continuous real-time images of the uterus during all stages of the surgical procedure. 28 procedures were performed. Results: There were 25 terminations of pregnancy between 7 and 24 weeks, one molar pregnancy evacuated, one endometrial polyp removed hysteroscopically, and one submucous resection of a myoma. The procedures were captured on video. In all cases, various surgical instruments were continually seen in real time. No intraoperative complications occurred. Conclusions: Transabdominal ultrasound requires an additional person, not involved in the surgical procedure, to operate the equipment. This TUAGS system allows a single individual to control the U/S while performing the surgical procedure. One hand holds the tenaculum, in this case tethered to the U/S probe, while the other hand can dilate or curette or resect in the usual fashion. Such continuous visualization can shorten operative time and increase safety, although further studies will be necessary.