Transvaginal interventional procedures: Aspiration, biopsy, and catheter drainage

Transvaginal ultrasonographically (US) guided procedures are simple and saf e and often represent the only means of access to pelvic disease. Aspiratio n of cystic pelvic masses and core biopsy of solid pelvic masses can be eas ily performed by using the transvaginal route, an endoluminal US transducer , and a needle guide. Because of concerns about false-negative diagnosis an d potential tumor seeding with biopsy of primary ovarian cystic lesions, th e indications for transvaginal aspiration and biopsy of ovarian and adnexal lesions are predominantly therapeutic. Similarly, using an endoluminal pro be with modification of the guide, one can also perform safe and effective trocar catheter drainage of pelvic abscesses via the transvaginal route. Th e transvaginal route is ideally suited to pelvic abscess drainage because o f the proximity of the vaginal fornices to most pelvic fluid collections. T he transvaginal route has the disadvantage of being semisterile; because of the risk of superinfecting previously noninfected pelvic pathologic condit ions, the transvaginal approach should be used only for solid lesions or cy stic lesions that can be completely aspirated. Familiarity with the transva ginal route of access is crucial for adequate treatment of many gynecologic and nongynecologic pelvic pathologic conditions.