Skip to main content
SpringerLink
Log in

Ultrasound-Guided Surgical Procedures

  • Chapter
  • First Online:
Ultrasound Imaging in Reproductive Medicine

Abstract

Ultrasonography plays an integral role not only in diagnostic testing but also in guiding hysteroscopic procedures, ovarian cyst and hydrosalpinx aspiration, difficult intrauterine device insertion and removal, and ART procedures such as oocyte retrieval and embryo transfer. The use of ultrasonography at the time of intrauterine procedures provides visualization of the intrauterine contents as well as the myometrium and may decrease procedure-associated risks, particularly uterine perforation. For hysteroscopic procedures such as uterine septum, myoma, or synechiae resection, operative ultrasonographic guidance provides an alternative to laparoscopy and, as a result, shortens overall operating time, decreases cost, and eliminates the risk of laparoscopy. In addition, performing intrauterine procedures under ultrasonographic guidance may increase the likelihood of completing the procedure in a single operation.

Assisted reproductive technology (ART) procedures such as oocyte retrieval and embryo transfer require ultrasonographic guidance for improved outcomes.

Portions of text reprinted from Session D, Kelly A, Goudas V, et al. Ultrasonographically guided intrauterine surgery. Female Pelvic Med Reconstr Surg. 1999;5(2):91–95. With permission from John Wiley & Sons, Inc.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Session DR, et al. Ultrasound-guided fallopian tube cannulation using Albunex. Fertil Steril. 1997;67(5):972–4.

    Article  CAS  PubMed  Google Scholar 

  2. Christianson MS, Barker MA, Lindheim SR. Overcoming the challenging cervix: techniques to access the uterine cavity. J Low Genit Tract Dis. 2008;12(1):24–31.

    Article  PubMed  Google Scholar 

  3. Wu MH, Hsu CC, Lin YS. Three-dimensional ultrasound and hysteroscopy in the evaluation of intrauterine retained fetal bones. J Clin Ultrasound. 1997;25(2):93–5.

    Article  CAS  PubMed  Google Scholar 

  4. Shalev E, Zuckerman H. Operative hysteroscopy under real-time ultrasonography. Am J Obstet Gynecol. 1986;155(6):1360–1.

    Article  CAS  PubMed  Google Scholar 

  5. Grimbizis GF, et al. Clinical implications of uterine malformations and hysteroscopic treatment results. Hum Reprod Update. 2001;7(2):161–74.

    Article  CAS  PubMed  Google Scholar 

  6. Acien P. Incidence of Mullerian defects in fertile and infertile women. Hum Reprod. 1997;12(7):1372–6.

    Article  CAS  PubMed  Google Scholar 

  7. Homer HA, Li TC, Cooke ID. The septate uterus: a review of management and reproductive outcome. Fertil Steril. 2000;73(1):1–14.

    Article  CAS  PubMed  Google Scholar 

  8. Propst AM, Hill 3rd JA. Anatomic factors associated with recurrent pregnancy loss. Semin Reprod Med. 2000;18(4):341–50.

    Article  CAS  PubMed  Google Scholar 

  9. Selvaraj P, Selvaraj K. Reproductive outcome of septate uterus following hysteroscopic septum resection. J Hum Reprod Sci. 2010;3(3):143–5.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Kupesic S, Kurjak A. Septate uterus: detection and prediction of obstetrical complications by different forms of ultrasonography. J Ultrasound Med. 1998;17(10):631–6.

    CAS  PubMed  Google Scholar 

  11. Daly DC, Maier D, Soto-Albors C. Hysteroscopic metroplasty: six years’ experience. Obstet Gynecol. 1989;73(2):201–5.

    CAS  PubMed  Google Scholar 

  12. Querleu D, Brasme TL, Parmentier D. Ultrasound-guided transcervical metroplasty. Fertil Steril. 1990;54(6):995–8.

    CAS  PubMed  Google Scholar 

  13. Fedele L, et al. Residual uterine septum of less than 1 cm after hysteroscopic metroplasty does not impair reproductive outcome. Hum Reprod. 1996;11(4):727–9.

    Article  CAS  PubMed  Google Scholar 

  14. Dabirashrafi H, Moghadami-Tabrizi N. Establishing the accuracy of ultrasound-guided transcervical metroplasty. Fertil Steril. 1991;56(1):152–3.

    CAS  PubMed  Google Scholar 

  15. Coccia ME, et al. Intraoperative ultrasound guidance for operative hysteroscopy. A prospective study. J Reprod Med. 2000;45(5):413–8.

    CAS  PubMed  Google Scholar 

  16. Cook H, et al. The impact of uterine leiomyomas on reproductive outcomes. Minerva Ginecol. 2010;62(3):225–36.

    CAS  PubMed  Google Scholar 

  17. Kresowik J, Syrop C, Van Voorhis B, Ryan G. Ultrasound is the optimal choice for guidance in difficult hysteroscopy. Ultrasound Obstet Gynecol. 2012;39:715–8.

    Article  CAS  PubMed  Google Scholar 

  18. Olive DL. The surgical treatment of fibroids for infertility. Semin Reprod Med. 2011;29(2):113–23.

    Article  PubMed  Google Scholar 

  19. Farhi J, et al. Induced regeneration of endometrium following curettage for abortion: a comparative study. Hum Reprod. 1993;8(7):1143–4.

    CAS  PubMed  Google Scholar 

  20. Ramzy AM, et al. Uterine myomata and outcome of assisted reproduction. Hum Reprod. 1998;13(1):198–202.

    Article  CAS  PubMed  Google Scholar 

  21. Jun SH, et al. Uterine leiomyomas and their effect on in vitro fertilization outcome: a retrospective study. J Assist Reprod Genet. 2001;18(3):139–43.

    Article  CAS  PubMed  Google Scholar 

  22. Surrey ES, Lietz AK, Schoolcraft WB. Impact of intramural leiomyomata in patients with a normal endometrial cavity on in vitro fertilization-embryo transfer cycle outcome. Fertil Steril. 2001;75(2):405–10.

    Article  CAS  PubMed  Google Scholar 

  23. Lin CC, et al. Myomectomy through the uterine cervix using forceps under sonographic guidance. Ultrasound Obstet Gynecol. 2009;33(2):228–31.

    Article  PubMed  Google Scholar 

  24. Wortman M, Dagget A. Hysteroscopic myomectomy. J Am Assoc Gynecol Laparosc. 1995;3(1):39–46.

    Article  CAS  PubMed  Google Scholar 

  25. Shalev E, Shimoni Y, Peleg D. Ultrasound controlled operative hysteroscopy. J Am Coll Surg. 1994;179(1):70–1.

    CAS  PubMed  Google Scholar 

  26. Myers EM, Hurst BS. Comprehensive management of severe Asherman syndrome and amenorrhea. Fertil Steril. 2012;97(1):160–4.

    Article  PubMed  Google Scholar 

  27. Orhue AA, Aziken ME, Igbefoh JO. A comparison of two adjunctive treatments for intrauterine adhesions following lysis. Int J Gynaecol Obstet. 2003;82(1):49–56.

    Article  CAS  PubMed  Google Scholar 

  28. Amer MI, Nadim EA, Karim H. The role of intrauterine balloon after operative hysteroscopy in the prevention of intrauterine adhesions; a prospective controlled study. Middle East Fertil Soc. 2005;10:135–9.

    Google Scholar 

  29. Pabuccu R, et al. Hysteroscopic treatment of intrauterine adhesions is safe and effective in the restoration of normal menstruation and fertility. Fertil Steril. 1997;68(6):1141–3.

    Article  CAS  PubMed  Google Scholar 

  30. Tsapanos VS, et al. The role of Seprafilm bioresorbable membrane in the prevention and therapy of endometrial synechiae. J Biomed Mater Res. 2002;63(1):10–4.

    Article  CAS  PubMed  Google Scholar 

  31. Acunzo G, et al. Effectiveness of auto-cross-linked hyaluronic acid gel in the prevention of intrauterine adhesions after hysteroscopic adhesiolysis: a prospective, randomized, controlled study. Hum Reprod. 2003;18(9):1918–21.

    Article  CAS  PubMed  Google Scholar 

  32. Letterie GS, Case KJ. Intraoperative ultrasound guidance for hysteroscopic retrieval of intrauterine foreign bodies. Surg Endosc. 1993;7(3):182–4.

    Article  CAS  PubMed  Google Scholar 

  33. Kohlenberg CF, Pardey J, Ellwood DA. Transabdominal ultrasound as an aid to advanced hysteroscopic surgery. Aust N Z J Obstet Gynaecol. 1994;34(4):462–4.

    Article  CAS  PubMed  Google Scholar 

  34. Goudas VT, Session DR. Hysteroscopic cervical cannulation under ultrasound guidance. A case report. J Reprod Med. 1998;43(8):696–8.

    CAS  PubMed  Google Scholar 

  35. Dabirashrafi H, Mohamad K, Moghadami-Tabrizi N. Three-contrasts method hysteroscopy: the use of real-time ultrasonography for monitoring intrauterine operations. Fertil Steril. 1992;57(2):450–2.

    CAS  PubMed  Google Scholar 

  36. Grimes DA, et al. Oral contraceptives for functional ovarian cysts. Cochrane Database Syst Rev. 2011;(9):CD006134.

    Google Scholar 

  37. Qublan HS, et al. Ovarian cyst formation following GnRH agonist administration in IVF cycles: incidence and impact. Hum Reprod. 2006;21(3):640–4.

    Article  CAS  PubMed  Google Scholar 

  38. Jenkins JM, et al. The detrimental influence of functional ovarian cysts during in-vitro fertilization cycles. Hum Reprod. 1992;7(6):776–80.

    CAS  PubMed  Google Scholar 

  39. Firouzabadi RD, Sekhavat L, Javedani M. The effect of ovarian cyst aspiration on IVF treatment with GnRH. Arch Gynecol Obstet. 2010;281(3):545–9.

    Article  PubMed  Google Scholar 

  40. Rizk B, et al. Ovarian cyst aspiration and the outcome of in vitro fertilization. Fertil Steril. 1990;54(4):661–4.

    CAS  PubMed  Google Scholar 

  41. Parinaud J, et al. Influence of ovarian cysts on the results of in vitro fertilization. Fertil Steril. 1992;58(6):1174–7.

    CAS  PubMed  Google Scholar 

  42. Tarlatzis BC, et al. Follicle cyst formation after administration of different gonadotrophin-releasing hormone analogues for assisted reproduction. Hum Reprod. 1994;9(11):1983–6.

    CAS  PubMed  Google Scholar 

  43. Greenebaum E, et al. Aspiration cytology of ovarian cysts in in vitro fertilization patients. Acta Cytol. 1992;36(1):11–8.

    CAS  PubMed  Google Scholar 

  44. Hurst BS, et al. Hydrosalpinx treated with extended doxycycline does not compromise the success of in vitro fertilization. Fertil Steril. 2001;75(5):1017–9.

    Article  CAS  PubMed  Google Scholar 

  45. Van Voorhis BJ, et al. Ultrasound-guided aspiration of hydrosalpinges is associated with improved pregnancy and implantation rates after in-vitro fertilization cycles. Hum Reprod. 1998;13(3):736–9.

    Article  PubMed  Google Scholar 

  46. Vandromme J, et al. Hydrosalpinges in in-vitro fertilization: an unfavourable prognostic feature. Hum Reprod. 1995;10(3):576–9.

    CAS  PubMed  Google Scholar 

  47. Osuga Y, et al. A case of hydrosalpinx associated with the menstrual cycle. Fertil Steril. 2008;90(1):199.e9-11.

    Article  PubMed  Google Scholar 

  48. Sowter MC, et al. Is the outcome of in-vitro fertilization and embryo transfer treatment improved by spontaneous or surgical drainage of a hydrosalpinx? Hum Reprod. 1997;12(10):2147–50.

    Article  CAS  PubMed  Google Scholar 

  49. de Wit W, et al. Only hydrosalpinges visible on ultrasound are associated with reduced implantation and pregnancy rates after in-vitro fertilization. Hum Reprod. 1998;13(6):1696–701.

    Article  PubMed  Google Scholar 

  50. Lenz S, Lauritsen JG, Kjellow M. Collection of human oocytes for in vitro fertilisation by ultrasonically guided follicular puncture. Lancet. 1981;1(8230):1163–4.

    Article  CAS  PubMed  Google Scholar 

  51. Barton SE, et al. Transabdominal follicular aspiration for oocyte retrieval in patients with ovaries inaccessible by transvaginal ultrasound. Fertil Steril. 2011;95(5):1773–6.

    Article  PubMed  Google Scholar 

  52. Gleicher N, et al. EGG retrieval for in vitro fertilisation by sonographically controlled vaginal culdocentesis. Lancet. 1983;2(8348):508–9.

    Article  CAS  PubMed  Google Scholar 

  53. Damario MA. Transabdominal-transperitoneal ultrasound-guided oocyte retrieval in a patient with mullerian agenesis. Fertil Steril. 2002;78(1):189–91.

    Article  PubMed  Google Scholar 

  54. Weinerman R, Grifo J. Consequences of superovulation and ART procedures. Semin Reprod Med. 2012;30(2):77–83.

    Article  CAS  PubMed  Google Scholar 

  55. Moini A, et al. Endometriosis may contribute to oocyte retrieval-induced pelvic inflammatory disease: report of eight cases. J Assist Reprod Genet. 2005;22(7–8):307–9.

    Article  PubMed  Google Scholar 

  56. Kroon B, et al. Antibiotics prior to embryo transfer in ART. Cochrane Database Syst Rev. 2012;3:CD008995.

    Google Scholar 

  57. Waterstone JJ, Parsons JH. A prospective study to investigate the value of flushing follicles during transvaginal ultrasound-directed follicle aspiration. Fertil Steril. 1992;57(1):221–3.

    CAS  PubMed  Google Scholar 

  58. Wongtra-Ngan S, Vutyavanich T, Brown J. Follicular flushing during oocyte retrieval in assisted reproductive techniques. Cochrane Database Syst Rev. 2010;(9):CD004634.

    Google Scholar 

  59. The Practice Committee of the American Society for Reproductive Medicine. Ovarian hyperstimulation syndrome. 2008. ASRM, Birmingham.

    Google Scholar 

  60. Penzias AS, Harris D, Barrett CB, Alper MM, Berger MJ, Oskowitz SP. Outcome oriented research in an IVF program: transfer catheter type affects IVF outcome. Cincinnati: ASRM; 1997.

    Google Scholar 

  61. Mansour R, Aboulghar M, Serour G. Dummy embryo transfer: a technique that minimizes the problems of embryo transfer and improves the pregnancy rate in human in vitro fertilization. Fertil Steril. 1990;54(4):678–81.

    CAS  PubMed  Google Scholar 

  62. Poindexter 3rd AN, et al. Residual embryos in failed embryo transfer. Fertil Steril. 1986;46(2):262–7.

    PubMed  Google Scholar 

  63. Leong M, et al. Ultrasound-assisted embryo transfer. J In Vitro Fert Embryo Transf. 1986;3(6):383–5.

    Article  CAS  PubMed  Google Scholar 

  64. Martinez F, et al. Ultrasound-guided embryo transfer: immediate withdrawal of the catheter versus a 30 second wait. Hum Reprod. 2001;16(5):871–4.

    Article  CAS  PubMed  Google Scholar 

  65. Matorras R, et al. Ultrasound-guided embryo transfer improves pregnancy rates and increases the frequency of easy transfers. Hum Reprod. 2002;17(7):1762–6.

    Article  CAS  PubMed  Google Scholar 

  66. Letterie GS, Marshall L, Angle M. A new coaxial catheter system with an echodense tip for ultrasonographically guided embryo transfer. Fertil Steril. 1999;72(2):266–8.

    Article  CAS  PubMed  Google Scholar 

  67. Strickler RC, et al. Ultrasound guidance for human embryo transfer. Fertil Steril. 1985;43(1):54–61.

    CAS  PubMed  Google Scholar 

  68. Woolcott R, Stanger J. Potentially important variables identified by transvaginal ultrasound-guided embryo transfer. Hum Reprod. 1997;12(5):963–6.

    Article  CAS  PubMed  Google Scholar 

  69. Hurley VA, et al. Ultrasound-guided embryo transfer: a controlled trial. Fertil Steril. 1991;55(3):559–62.

    CAS  PubMed  Google Scholar 

  70. Kan AK, et al. Embryo transfer: ultrasound-guided versus clinical touch. Hum Reprod. 1999;14(5):1259–61.

    Article  CAS  PubMed  Google Scholar 

  71. Coroleu B, et al. The usefulness of ultrasound guidance in frozen-thawed embryo transfer: a prospective randomized clinical trial. Hum Reprod. 2002;17(11):2885–90.

    Article  CAS  PubMed  Google Scholar 

  72. Coroleu B, et al. The influence of the depth of embryo replacement into the uterine cavity on implantation rates after IVF: a controlled, ultrasound-guided study. Hum Reprod. 2002;17(2):341–6.

    Article  PubMed  Google Scholar 

  73. Lesny P, et al. Embryo transfer–can we learn anything new from the observation of junctional zone contractions? Hum Reprod. 1998;13(6):1540–6.

    Article  CAS  PubMed  Google Scholar 

  74. Goudas VT, et al. Blood on the embryo transfer catheter is associated with decreased rates of embryo implantation and clinical pregnancy with the use of in vitro fertilization-embryo transfer. Fertil Steril. 1998;70(5):878–82.

    Article  CAS  PubMed  Google Scholar 

  75. Buckett WM. A meta-analysis of ultrasound-guided versus clinical touch embryo transfer. Fertil Steril. 2003;80(4):1037–41.

    Article  PubMed  Google Scholar 

  76. Brown J, et al. Ultrasound versus ‘clinical touch’ for catheter guidance during embryo transfer in women. Cochrane Database Syst Rev. 2010;(1):CD006107.

    Google Scholar 

  77. Trussell J, Vaughan B. Contraceptive failure, method-related discontinuation and resumption of use: results from the 1995 National Survey of Family Growth. Fam Plann Perspect. 1999;31(2):64–72, 93.

    Article  CAS  PubMed  Google Scholar 

  78. Kaislasuo J, et al. Intrauterine contraception: incidence and factors associated with uterine perforation–a population-based study. Hum Reprod. 2012;27(9):2658–63.

    Article  PubMed  Google Scholar 

  79. Hayes JL, et al. A pilot clinical trial of ultrasound-guided postplacental insertion of a levonorgestrel intrauterine device. Contraception. 2007;76(4):292–6.

    Article  CAS  PubMed  Google Scholar 

  80. de Kroon CD, et al. The value of transvaginal ultrasound to monitor the position of an intrauterine device after insertion. A technology assessment study. Hum Reprod. 2003;18(11):2323–7.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, 550 Peachtree Street, Suite 1800, Atlanta, GA, 30308, USA

    Donna R. Session MD & Jennifer F. Kawwass MD

Authors
  1. Donna R. Session MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jennifer F. Kawwass MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Donna R. Session MD .

Editor information

Editors and Affiliations

  1. Department of Obstetrics and Gynecology, Eastern Virginia Medical School Jones Institute for Reproductive Medicine, Norfolk, Virginia, USA

    Laurel Stadtmauer

  2. Institute for Human Reproduction, Chicago, Illinois, USA

    Ilan Tur-Kaspa

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Session, D.R., Kawwass, J.F. (2014). Ultrasound-Guided Surgical Procedures. In: Stadtmauer, L., Tur-Kaspa, I. (eds) Ultrasound Imaging in Reproductive Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-9182-8_21

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-9182-8_21

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-9181-1

  • Online ISBN: 978-1-4614-9182-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation