In experienced hands, ultrasound provides at least as good success rates as other methods of peripheral nerve location. Individual studies have demonstrated that ultrasound may reduce complication rates and improve quality, performance time, and time to onset of blocks. Due to wide variations in study outcomes we chose not to combine the studies in our analysis.

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The aim of this study was to validate temporally and externally the ultrasound-based endometriosis staging system (UBESS) to predict the level of complexity of laparoscopic surgery for endometriosis. Design: A multicenter, international, retrospective, diagnostic accuracy study was carried out between January 2016 and April 2018 on women with suspected pelvic endometriosis. Setting: Four different centers with advanced ultrasound and laparoscopic services were recruited (1 for temporal validation and 3 for external validation). Patients: Women with pelvic pain and suspected endometriosis. Interventions: All women underwent a systematic transvaginal ultrasound and were staged according to the UBESS system, followed by classification of laparoscopic level of complexity according to the Royal College of Obstetricians and Gynaecologists (RCOG) levels 1 to 3. Measurements and Main Results: UBESS I, II, and III were then correlated with RCOG levels 1, 2, and 3, respectively. A comparison between temporal and external sites (skipping "A") and between each site was performed in terms of the diagnostic accuracy of UBESS to predict RCOG laparoscopic skill level. A total of 317 consecutive women who underwent laparoscopy with suspected endometriosis were included. Complete transvaginal ultrasound and laparoscopic surgical outcomes were available for 293/317 (92.4%). At the temporal site, the accuracy, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of UBESS I to predict RCOG level 1 were 80.

Objective To investigate how many examinations it takes to be able to identify the pelvic parts of the ureters on transvaginal sonography (TVS). Methods This was a prospective study including consecutive women attending a gynecological outpatient clinic in a tertiary referral setting. Prior to commencement of the study, three trainees, with a focus on gynecological surgery and TVS but with no experience in identifying ureters, each observed an expert examiner performing 10 routine TVS examinations, including identification of both ureters. All were standardized gynecological TVS examinations, with visualization of the pelvic part of both ureters. Consecutive women were then examined, first by the expert, unobserved by the trainees, and then by one of the three trainees, in the presence of the expert. To ensure that identification of the pelvic parts of the ureters could be incorporated feasibly into routine gynecological TVS in a tertiary referral setting, a time limit of 150 s was set for successful identification of each ureter. A successful examination was defined by identifying both ureters within the time limit. The number of women examined by each trainee was determined by how quickly they achieved proficiency, which was evaluated using the learning curve cumulative summation (LC‐CUSUM) score. Results Between January 2017 and June 2017, a total of 140 women were recruited for the study, with 135 patients being included in the final analysis. The three trainees were able to identify the right ureter after a maximum of 48 (range, 34–48) TVS examinations, and the left ureter after a maximum of 47 (range, 27–47) TVS examinations. Conclusions Sonographers and/or gynecologists who are familiar with gynecological TVS should be able to become proficient in identifying both ureters after 40–50 TVS examinations. Detection of the ureters is a feasible part of the TVS workup of patients attending a clinic in a tertiary referral center. © 2019 the Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

Short oral presentation abstractsin Group 1 and 5.7±3.5 in Group 2 (p = 0.0004). No statistically significant differences were found in the rest of symptoms. Only 4 patients reported haematuria (3 with infiltrative nodules). Up to 17/22 patients had adenomyosis (7 in the anterior wall). Up to 11/22 women presented endometriomas, 13/22 rectosigmoid, 15/22 retrocervical and uterosacral, 8 vaginal endometriosis, 17 ovarian fixity and 11 a negative sliding sign. No differences were observed between groups in the location of other types of endometriosis. Conclusions: Women with more infiltrative nodules referred more dysuria than women with nodules that not protrude in the bladder cavity. Women with BE had frequently associated other types of endometriosis. Bladder nodules do not usually affect ureteral meatus and do not frequently cause hydronephrosis. OP14.10External and temporal validation of the ultrasound-based endometriosis staging system (UBESS): a diagnostic accuracy study

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Objectives:To evaluate the accuracy of TVS for preoperative detection of bladder endometriosis (BE) and to describe TVS-based surgical outcomes of women undergoing laparoscopic procedures for UTE including BE and/ or hydronephrosis (HN). Methods: Retrospective cohort study of patients with suspected deep infiltrating endometriosis (DIE) as demonstrated by TVS underwent radical laparoscopic resection, which consisted of laparoscopic partial cystectomy (PC), ureterolysis (UL), ureteric end-to-end anastomosis (UEEA) or ureteroneocystostomy (UNC) at our department. Results: Out of 207 patients with DIE, 43 exhibited UTE consisting of 25 patients with BE and 20 women with solitary or additional HN. Sensitivity, specificity, positive and negative predictive values and likelihood ratios for TVS regarding BE were 96%, 99%, 96%, 99%; 174,7 (24.7-1235.7 95% CI) and 0.04 (0.01-0.27 95% CI). All women with BE underwent PC. In cases of HN, 14 conservative ULs, 3 UEEAs and 3 UCNs were performed. Thirteen women with concomitant DIE of the rectum also underwent bowel resection. Laparoscopic surgery was feasible in 41/43 (conversion rate 5%) women with UTE. Median duration of surgery was 200 minutes, median blood loss 1.6 g/d with a median hospital stay of 8.6 days. We observed 3 complications according to Clavien-Dindo III including 1 leak following UEEA, 1 re-stenosis after UL and 1 subcutaneous hematoma. After a median follow-up of 29.5 months, we observed a significant decrease in dysmenorhhea (7.7 to 1.3; p=0.001), dyspareunia (3.8 to 1.1, p=0.001), dysuria (3.3 to 1.1; p=0.001) and increase in QoL (3.1 to 8.3; p=0.001). In subfertile women (23/43, 54%), the overall clinical pregnancy rate and life birth rate was 44% and 33%. Conclusions: TVS is highly accurate for presurgical diagnosis of BE. Laparoscopic surgery for BE and UTE including HN is safe, feasible and efficient regarding reduction of pain symptoms and treatment of subfertility with a low rate of complications. OC22.02Diagnostic accuracy of the transvaginal ultrasound ''sliding sign'', direct visualisation and combination of both for the prediction of deep infiltrating endometriosis of the rectum and the rectosigmoid M. Espada 6 , C. Objectives: 1. To evaluate the diagnostic accuracy of transvaginal ultrasound (TVS) direct visualisation (DV) of rectal/rectosigmoid (RS) nodules compared to the "sliding sign" (SS) to predict deep infiltrating endometriosis (DIE) of the rectum ® and the RS during laparoscopy.2.To evaluate the diagnostic accuracy of the combination of both techniques (DV+SS) to predict DIE of the R or the RS. Methods: Multicentre prospective observational study from January 2009 to February 2017,including patients with suspected endometriosis. All women underwent TVS to evaluate the ''sliding sign'' or if a nodule within the rectal/rectosigmoid wall was visualised, followed by laparoscopic surgery. The association between the SS and the DV during the TVS were correlated to the presence of rectal/rectosigmoid DIE at laparoscopy. Fisher's exact test wa...