Enhancing Surgical Outcomes: Study Explores the Impact of Intraoperative Ultrasound in Complex Procedures

A multicentre pilot study published in the European Journal of Obstetrics & Gynecology and Reproductive Biology showed that a large RCT comparing surgical management of miscarriage with and without intraoperative ultrasound is feasible.

"Intraoperative ultrasound could reduce the number of unsuccessful procedures or complications following surgical management of miscarriage (SMM)," the researchers wrote.

Paul P. Smith from Birmingham Women’s Hospital in Birmingham, UK, and colleagues aimed to test whether intraoperative ultrasound can reduce the incidence of early and late complications following surgical removal of products of conception.

For this purpose, the researchers conducted a prospective, multicentre, randomized, open clinical trial to assess feasibility. It was conducted in two University Teaching hospitals in the West Midlands, England.

The population comprised women aged 16 years or over referred for surgical management of miscarriage. Participants were randomly assigned to undergo surgical management for miscarriage with either continuous intraoperative ultrasound guidance or without it.

Process outcomes assessed during the study encompassed the percentage of eligible women screened and randomized, attrition rates, evaluation of outcome measurement tools, and acceptability among participants. The primary clinical endpoint focused on a composite outcome combining unsuccessful procedures or complications.

The study led to the following findings:

· Fifty-nine women requiring surgical management of miscarriage were randomized.

· The conversion rate for entry into the trial was 75%.

·19% of the patients who had surgery without ultrasound and 25% who had surgery with ultrasound (RR = 0.74) attained the composite clinical outcome.

· When patients who could not attend their hysteroscopy appointment, due to the COVID-19 pandemic were excluded, 19 % of patients who had surgery without ultrasound and 20% of patients who had surgery with ultrasound attained the composite clinical outcome (RR = 0.93).

In summary, the SEE U randomized controlled trial underscores the transformative potential of intraoperative ultrasound in enhancing surgical precision and patient safety during uterine evacuation procedures, marking a significant advancement in gynecological surgical techniques.

Reference:

Smith PP, Cheed V, Middleton L, Devall AJ, Izzat F, Clark TJ. Surgical evacuation with intraoperative ultrasound (SEE U): A randomised controlled trial. Eur J Obstet Gynecol Reprod Biol. 2024 Jul;298:6-11. doi: 10.1016/j.ejogrb.2024.04.004. Epub 2024 Apr 8. PMID: 38705012.