Ultrasound guidance during endoscopic procedures

The dual endoscopic modalities of laparoscopy and hysteroscopy have progressed from strictly diagnostic studies designed to evaluate the causes of gynecologic complaints, such as pelvic pain and infertility, to operative procedures encompassing a multitude of complex surgeries. The evolution of endoscopic instrumentation has enabled procedures formerly performed only by laparotomy and microsurgery to be completed by endoscopy as minimally invasive procedures. Near simultaneous evolution of ultrasound transducers from relatively primitive and cumbersome A-mode equipment to real-time, sophisticated, miniaturized transducers encased in catheters and endoscopic sheaths has permitted the introduction of intraoperative sonographic monitoring. This article outlines the evolution of endoscopic sonography and reviews its applications to gynecologic laparoscopic and hysteroscopic operative procedures.