Lectures

Extending the routine gynaecological ultrasound.

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Transvaginal ultrasound is considered an essential tool for the assessment of pelvic pathology and is often used as a first-line investigation for women with gynaecological symptoms. Initially, only pathologies of the uterus and ovaries could be assessed but with improvements in equipment and particularly the development of specific skills and scanning techniques, it has also become possible to diagnose other gynaecological disorders affecting structures beyond the uterus or ovaries such as deep endometriosis. Despite good test characteristics and an acceptable learning curve, even after more than 10 years, the endometriosis assessment is still considered a specialist assessment. Unless every routine ultrasound examination is extended beyond the uterus and ovaries into the posterior and anterior pelvic compartments to evaluate structural mobility and to look for deep endometriotic nodules, endometriosis will continue to be missed which denies affected women a pre-operative diagnosis and an opportunity of having a single, well-planned procedure in the hands of a well-prepared team. It is therefore time for endometriosis assessment to become an essential part of every routine gynaecological ultrasound examination.

Lectures and cases are structured into levels of difficulty. We suggest you begin with finding out what endometriosis is, familiarise yourself with normal findings and severe disease before progressing to subtle findings.

What is endometriosis?

 
 

This patient information video gives patients an understanding of what can be seen on ultrasound. And that a normal ultrasound does not exclude endometriosis.

By Sofie Piessens

This presentation contains many laparoscopic clips and images allowing you to gain an understanding of the surgical appearance and complexity of endometriosis

By Luk Rombauts

This presentation outlines the general approach to the diagnosis of endometriosis and the part transvaginal ultrasound can play.

By Sofie Piessens

This presentations highlights why it is time to include assessment for the most common gynaecological condition in the routine gynaecological ultrasound.

By Sofie Piessens

The extended routine gynae scan

 
Unless every routine ultrasound examination is extended beyond the uterus and ovaries into the posterior and anterior pelvic compartments to evaluate structural mobility and to look for deep endometriotic nodules, endometriosis will continue to be missed which denies affected women a pre-operative diagnosis and an opportunity of having a single, well-planned procedure in the hands of a well-prepared team.
 

This clip demonstrates the most important manoeuvre in the assessment for endometriosis. If you only remember one thing, it should be to put the ultrasound probe in the posterior fornix!

By Karl Rombauts

Learn how the uterus, ovaries, bladder, ureters, vaginal vaults, uterosacral ligaments and bowel relate to each other in a normal pelvis.

By Sofie Piessens

Endometriosis is common affecting 10% of women. To allow a preoperative diagnosis, the routine gynae scan should assess the anterior and posterior compartment.

By Sofie Piessens

Red flags for endometriosis allow you to suspect the disease the moment you insert the probe. It is particularly important then to extend the scan in the anterior and posterior compartment.

By Sofie Piessens

Recognising severe disease

 
 

Endometriomas are often associated with deep endometriosis. Their appearance can change in pregnancy and malignant transformation is possible after menopause.

By Andrew Edwards

Pouch of Douglas obliteration makes surgery significantly more difficult and can be assessed with the ‘sliding’ sign.

By Sofie Piessens

Normal appearances of the bowel on ultrasound and how to assess the bowel for endometriosis nodules.

By Jing Fang

Bladder and ureteric endometriosis is more rare but it is important to look at the bladder and ureters as a urologist is required during the surgery if there are bladder or ureteric nodules present.

By Rebecca Long

Finding subtle lesions

 
 

This presentation on subtle lesions in the pouch of Douglas teaches you to assess the uterosacral ligaments.

By Sofie Piessens

Full of tips and tricks that make it easier to start scanning for deep endometriosis.

By Rebecca Long

 
 

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