Abstract
Objective: Vaginally assisted NOTES hysterectomy (VANH) is challenging in cases with pouch of Douglas adhesions. This study aimed to evaluate the accuracy of preoperative MRI in predicting these adhesions to aid surgical decision-making.
Method: We retrospectively analyzed 10 VANH and 10 retrograde total laparoscopic hysterectomy (TLH) cases performed between January and April 2024. MRI findings were assessed by two evaluators (a gynecologist and a radiologist) based on seven criteria including uterine retroflexion, vaginal vault elevation, and bowel tethering. Findings were compared with surgical observations.
Results: All retrograde TLH cases had adhesions, whereas no adhesions were found in VANH cases. Retrograde TLH showed more positive MRI findings (mean: 3.4 vs. 0.6). Bowel tethering and plaque-like low-intensity signals on the uterine serosa were the most reliable indicators of pouch of Douglas adhesions. The agreement rate between evaluators was 88.6%.
Conclusion: Our findings suggest that MRI effectively predicts pouch of Douglas adhesions. Key findings, such as bowel tethering and serosal plaque-like signals, may be useful in selecting the safest surgical approach, thereby reducing complications and improving outcomes.
