a vaginal route with laparoscopic pelvic lymphadenectomy. Abdominal radical trachelectomy has also been performed, but does not have the reproductive success. Robotic approach to the abdominal technique permits more precise surgery, preservation of the vasculature to the uterus, and minimal manipulation of the reproductive organs. This is the first report of this procedure and describes the technique. FRIDAY, OCTOBER 31, 2008 122 Plenary Session 10dPregnancy Issues (10:30 AM d 10:40 AM) Clinical Algorithm for Evaluation and Management of Interstitial (Cornual) Ectopic Pregnancies Krotz SP, Frishman GN. Obstetrics & Gynecology, Brown University, Providence, Rhode Island Study Objective: To design a clinical algorithm for the evaluation and treatment of interstitial (cornual) pregnancies based on clinical studies and recent medical literature. Design: A Medline Search was performed using the search terms ‘‘interstitial’’ and ‘‘cornual’’ pregnancy to identify a total of 336 studies. We define interstitial (cornual) pregnancy as a pregnancy in the proximal portion of the fallopian tube surrounded by myometrium. Studies with larger patient cohorts and clinically useful findings were incorporated into the algorithm design. Setting: University Hospital. Intervention: Clinical algorithm design. Measurements and Main Results: Of the 336 studies, data from 38 studies inclusive of 144 patients were used to construct a clinically useful management algorithm for interstitial (cornual) ectopic pregnancies. Risk factors include in vitro fertilization, previous ectopic pregnancy, previous salpingectomy and sexually transmitted infections. Symptomatic patients with BhCG values O2000 mIU/mL should undergo transvaginal ultrasound evaluation for the Interstitial Sign or criteria outlined by Timor-Tritsch, and if inconclusive, undergo MR evaluation. Surgical diagnosis is last resort. Patients with a cornual pregnancy !23 mm are good candidates for multi-dose systemic or local methotrexate administration with success rates of 79% and 91% respectively. Those with BhCG values O12,000 mIU/mL, a gestational sac O23 mm or O8 weeks gestational age may be at greater risk for methotrexate failure and should be considered for endoscopic management if appropriate candidates. Conclusion: Newer studies indicate that interstitial (cornual) ectopic pregnancies deserve more conservative management than previously employed. Design of an algorithm for evaluation and treatment of interstitial (cornual) ectopic pregnancy will serve as a model for future decision-making and provide a testable hypothesis for refinement of management criteria. Medical treatment (either systemic or local) and laparoscopic cornual or endo-loop resection have replaced exploratory laparotomy as first line approach; hysteroscopic approaches still remain investigational. 123 Plenary Session 10dPregnancy Issues (10:41 AM d 10:51 AM) Three-Dimensional (3D) Coded Contrast Imaging: A New Ultrasound Approach to Evaluate Tubal Patency Excaoustos C, 1 Zupi E, 1 Szabolcs B, 1 Romanini ME, 1 Falkensammer P, 2 Gabardi C, 2 Arduini D. 1 1 Department of Obstetrics and Gynecology, Universita`degli Studi di Roma ‘‘Tor Vergata,’’ Rome, Italy; 2 GE Healthcare, Zipf, Austria Study Objective: Transvaginal hystero-salpingo-contrast-sonography (TVS HyCoSy) with air-saline mix solution appears to be an accurate and inexpensive screening tool to assess tubal patency. However, HyCoSy with saline-air mix solution has some limitations. Since the surrounding bowel and the fimbrial ends have similar echogenicity, is not easy to visualize spillage of the saline-air mix at the distal portion of the tubes. The aim of this study is to assess the validity of a new dedicated contrast- enhanced ultrasound technology in the evaluation of tubal patency and in the visualization of tubal course. Design: TVS HyCoSy with the 3D ‘‘Coded Contrast Imaging’’ (CCI) technology was performed before laparoscopic chromoperturbation. Setting: University hospital. Patients: Twenty infertile patients scheduled for laparoscopy. Intervention: TVS HyCoSy with the 3D CCI technology (GE Healthcare) was performed during intrauterine injection of the second-generation contrast agent. The CCI allows the detection of contrast in the tube by discriminating the harmonic answer of contrast microbubbles from ultrasound echoes coming from other tissues and organs. We used laparoscopic chromoperturbation as our gold standard for determine tubal patency and tubal morphology. Measurements and Main Results: Of the 20 patient that underwent 3D HyCoSy, 5 showed a tubal occlusion. 3D HyCoSy with this new software demonstrated a high concordance for tubal status with laparoscopic dye test (96%). Conclusion: The major advantages of 3D HyCoSy with CCI are: 1. The imaging of the tube is produced only by contrast microbubbles and the broadband ultrasonic signals from surrounding tissue are filtered out completely. 2. The view of hyperechoic contrast media inside the tube in a completely anechoic pelvic cavity, make this diagnostic method easier for even an inexperienced sonographer. 3. The visualization for few minutes of the contrast media makes possible the use of 3D examination showing the tubal course in different planes and in the space. 124 Plenary Session 10dPregnancy Issues (10:52 AM d 11:02 AM) Extensive Excision of Deep Infiltrative Endometriosis before In Vitro Fertilization Significantly Improves Pregnancy Rates Bianchi PHM, Zanatta A, Hassun PA, Alegretti JR, Motta ELA, Serafini PC. Huntington Medicina Reprodutiva, Sa˜o Paulo, Brazil Study Objective: To compare the outcomes of in vitro fertilization treatments in women that choose to or declined to underwent laparoscopic extensive excision of deep infiltrative endometriosis. Design: Patient self-randomized, prospective study . Setting: Infertility clinic and private hospital in Sao Paulo, Brazil. S33 Abstracts / Journal of Minimally Invasive Gynecology 15 (2008) S1eS159