Division of Obstetrics and Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Division of Obstetrics and Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Fertil Steril. 2021 Jul;116(1):275-277. doi: 10.1016/j.fertnstert.2020.11.019. Epub 2021 Feb 12.
To show a step-by-step technique to assess normal uterosacral ligaments (USLs) during transvaginal ultrasound. Uterosacral ligaments represent the most common location of deep infiltrating endometriosis (DIE) in the posterior compartment and their involvement significantly increases the risk of ureteral lesions. The ultrasonographic diagnosis of DIE involving USLs is characterized by a wide range of accuracies described between studies, probably due to variations in the examination technique, quality of ultrasound equipment, and experience of the operators. Although described as a new classification system of DIE involving USLs, the technique for visualizing normal USLs has not yet been described.
Stepwise demonstration of the technique with narrated video footage.
Academic tertiary hospital.
PATIENT(S): The video shows a 33-year-old nulliparous woman scheduled for laparoscopic removal of a para-ovarian cyst of approximately 6 cm. Procedural steps were repeated and confirmed in another four patients submitted to laparoscopy for benign diseases (Table 1). Moreover, we here show the case of a 29-year-old woman with an isolated DIE nodule of the right USL with a comparison of laparoscopic and ultrasound findings. To better point out the technique applied in a clinical setting we show also cases of infiltrated USLs (Table 2) during the ultrasound scan in women scheduled for endometriosis surgery. Informed consent was obtained from all of the patients. The study protocol was approved by the local institutional Ethics Committee (580/2018/Oss/AOUBo).
INTERVENTION(S): To understand correctly the right position of USLs we performed an ultrasound during a surgical procedure; in this way it was possible to recognize the area of interest while the surgeon filled the pouch of Douglas with fluid and highlighted the anatomical area with pliers. Uterosacral ligaments can be seen in the mid-sagittal and transverse view of the uterus.
MAIN OUTCOME MEASURE(S): Description of appearance of normal USLs during transvaginal ultrasound.
RESULT(S): Uterosacral ligaments, at transvaginal ultrasound, appear as hyperechoic stripes starting from the cervix and pointing laterally in a semi-horizontal direction.
CONCLUSION(S): We provided a step-by-step technique (Table 3) that may be a useful tool to see accurately both the USLs at transvaginal ultrasound.
展示经阴道超声评估正常子宫骶韧带（USL）的分步技术。子宫骶韧带是后盆腔深部浸润性子宫内膜异位症（DIE）最常见的部位，其受累显著增加输尿管损伤的风险。USL 深部浸润性子宫内膜异位症的超声诊断具有研究间报道的准确性差异较大的特点，这可能与检查技术、超声设备质量和操作人员经验的差异有关。尽管描述了一种新的涉及 USL 的 DIE 分类系统，但尚未描述可视化正常 USL 的技术。
带有旁白视频片段的分步演示技术。
学术三级医院。
该视频展示了一位 33 岁的未产妇，计划行腹腔镜切除约 6cm 的卵巢旁囊肿。在另外 4 名因良性疾病行腹腔镜检查的患者中重复并确认了手术步骤（表 1）。此外，我们还展示了一名 29 岁的右侧 USL 孤立性 DIE 结节患者的病例，比较了腹腔镜和超声检查结果。为了更好地指出在临床环境中应用的技术，我们还展示了在因子宫内膜异位症手术而接受检查的女性中浸润性 USL（表 2）的病例。所有患者均获得知情同意。该研究方案获得了当地机构伦理委员会的批准（580/2018/Oss/AOUBo）。
为了正确理解 USL 的正确位置，我们在手术过程中进行了超声检查；通过这种方式，当外科医生用液体填充道格拉斯袋并使用钳子突出解剖区域时，就可以识别出感兴趣的区域。子宫骶韧带在子宫的中矢状面和横切面可以看到。
描述经阴道超声检查中正常 USL 的外观。
子宫骶韧带在经阴道超声检查中呈现为从宫颈开始并向外侧呈半水平方向指向的高回声条纹。
我们提供了一种分步技术（表 3），这可能是在经阴道超声检查中准确观察 USL 的有用工具。
