Transvaginal Interventional Procedures: Aspiration, Biopsy, and Catheter Drainage

Abstract

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

Aspiration and ethanol sclerotherapy to treat recurrent ovarian endometriomas prior to in vitro fertilization – a pilot study

“…It may be used before the induction of ovulation in IVF programs. In addition, the use of alcohol appears to significantly reduce the symptoms associated with endometriomas, with a decreased risk of adhesion formation because the procedure is intratumoral (29) . This study demonstrated an effective remission of endometrioma volume after aspiration and the use of alcohol in all reported cases.…”

Computed tomography-guided percutaneous abscess drainage in coloproctology: review of the literature

“…The indications for transvaginal drainage of pelvic fluid collections include both gynecologic and non-gynecologic conditions, such as simple or complex tubo-ovarian abscesses, postoperative abscesses and diverticular abscesses. In the literature, success rates close to 100% using a US-guided transvaginal approach have been reported but all the studies enrolled small populations and lacked statistical significance [62,[72][73][74][75][76][77]. More recently, Rose et al [78] studied a larger population (n=46) and reported that 3D reconstruction during the US-guided approach can add substantial information on structure and spatial resolution to optimize the initial drainage of complex fluid collections.…”

Procedimentos percutâneos pélvicos guiados por imagem: revisão das principais vias de acesso

“…Prophylactic intravenous antibiotic-therapy (cephoxitin 1g or clindamycin 1g + gentamycin 80 mg + ampicillin 1g) is mandatory. Additionally a 300 mg-dose of clindamycin each six hours for five days may be recommended (5) .…”

“…Collections and cysts must be completely drained in order to avoid hyperinfection by the rectovaginal flora (5) .…”

“…Image-guided percutaneous biopsy and drainage have been established as safe and effective procedures within the practice of interventional radiology, accounting for the majority of nonvascular procedures in departments of imaging diagnosis. These methods represent safe and effective tools for a minimally invasive management of different clinical and surgical conditions, if appropriately performed (1)(2)(3)(4)(5)(6)(7)(8) .…”