Invasive procedures in the female pelvis: Value of transabdominal, endovaginal, and endorectal US guidance

Transabdominal, endovaginal, and endorectal ultrasonographic (US) guidance is indispensable for a multitude of invasive procedures in the female pelvi s. Transabdominal uterine US performed with a fluid-filled bladder is appro priate and convenient for guidance of difficult dilation and curettage proc edures. Transabdominal intraoperative US can be employed to guide several p rocedures for which the more expensive intraoperative hysteroscopic procedu re is now used. Aspiration of symptomatic ovarian cysts that appear benign at US with an endovaginally guided small-gauge needle is simple and effecti ve. Simple noninfected pelvic fluid collections may be aspirated transvagin ally for both diagnosis and therapy by using endovaginal guidance. Endovagi nal US demonstrates the anatomic relationships of a pelvic abscess to adjac ent structures, allowing safe access for transvaginal drainage. By using an endovaginal transducer with a needle guide, cervical and vaginal cuff mass es may be easily sampled. An obstructed uterus may be accessed by puncturin g obstructive tissue with a trocar-containing needle guided by an endorecta l probe. US. guidance for placement of a central brachytherapy tandem is pe rformed via the abdominal approach after the bladder has been distended wit h sterile water. Endorectal US transducers may be effectively used to guide placement of interstitial brachytherapy needles in pelvic soft-tissue mass es.