OP17.05: Improving outcomes in hysteroscopic surgery using intraoperative ultrasound: current evidence

To comprehensively review the published information and evaluate the available evidence on the application and usefulness of intraoperative ultrasound (IOUS) in hysteroscopic surgery. A literature review was conducted by searching 4 databases (MEDLINE, EMBASE, The Cochrane Library and Web of Science), using the keywords “intraoperative ultrasound” and “hysteroscopy”. The selection was restricted to the papers published in English, spanning from the inception of these databases up to September 1st, 2023. From 145 potentially relevant articles, 20 publications focused directly on IOUS in hysteroscopic surgery. Relevant data were extracted from these articles and their references. The GRADE approach was used to determine the evidence quality. Many hysteroscopic interventions can be effectively and safety executed via direct hysteroscopic visualisation. In hysteroscopic myomectomy, IOUS significantly reduces the risk of uterine perforation and subsequent complications, particularly in submucosal FIGO 2 myomas with substantial intramural involvement (evidence quality: grade 1B). By augmenting the feasibility of single-step hysteroscopic myomectomy, IOUS may reduce overall treatment costs and the inconvenience associated with multiple procedures. In hysteroscopic metroplasty, IOUS decreases incomplete uterine septum resection (evidence quality: grade 1B). In hysteroscopic management of severe Asherman syndrome, IOUS reduces the risk of uterine perforation or false passage (evidence quality: grade 1C). In patients with Caesarean scar pregnancy (CSP), ultrasound is crucial to define the most appropriate surgical approach and effective to guide hysteroscopic treatment of endogenic CSP (evidence quality: grade 1C). Although the routine use of IOUS in hysteroscopic surgery may not be imperative, it appears to be a valuable adjunct, especially in complex cases where the risk of uterine perforation or incomplete lesion resection is increased.