1588 Image-guided surgery provides the ability to track in- struments in real time during a procedure. These techniques have assumed an essential role in a variety of surgical specialties, including general surgery and neurosurgery. Its application to gynecologic surgery has been primarily for intraoperative guidance of endo- scopic surgery, both hysteroscopic and laparoscopic. 1,2 Miniaturized high-frequency transducers provide excel- lent resolution, are easily maneuvered and may enhance surgical precision during intra-abdominal gynecologic surgery. A 7.5-MHz finger-grip probe was used for intra- operative guidance in two settings: the first to guide trans- abdominal myomectomies and the second to guide excision of blind uterine horns in complicated recon- structive surgery for mullerian abnormalities. Case series Six patients were treated: three patients with multiple leiomyomas and three patients with complex obstructive mullerian abnormalities. Patients with myomata were ages 28, 37, and 44 years, in good health with complaints of menorrhagia, metrorrhagia, pelvic pressure, or urinary frequency. Myomas ranged from 2 to 8.5 cm in size and from two to six in number and were submucous, sub- serosal, and intramural in location. Patients with ob- structed uterine horns were aged 16, 18, and 22 years, in good health, with complaints of progressive pelvic pain and pelvic pressure. These obstructive abnormalities were defined preoperatively by ultrasound and magnetic resonance imaging. In one patient (age 18 years), a pre- vious surgery 2 years earlier at another institution at- tempted unsuccessfully to establish patency between the obstructed uterine horn and the vagina. The technique of intraoperative ultrasound imaging consisted of placing the 7.5-MHz finger-grip probe into a sterile sleeve and drawing it onto the field for intra-ab- dominal imaging. The probe was used by grasping it be- tween the index and middle fingers (Fig 1). Adjustments for image quality by using brightness, gain, and contrast were controlled by operating room staff. For those pa- tients with uterine myomata, a pediatric Foley catheter From the Center for Fertility and Reproductive Endocrinology, Virginia Mason Medical Center, a and the National Institute of Child Health and Human Development, National Institutes of Health. b Received for publication January 9, 2002; revised May 24, 2002; ac- cepted July 12, 2002. Reprint requests: Gerard S. Letterie, MD, Virginia Mason Medical Cen- ter, 1100 Ninth Ave (X11-FC), Seattle, WA 98110. © 2002, Mosby, Inc. All rights reserved. 0002-9378/2002 $35.00 + 0 6/1/128400 doi:10.1067/mob.2002.128400 A 7.5-MHz finger-grip ultrasound probe for real-time intraoperative guidance during complex reproductive surgical procedures Gerard S. Letterie, MD, FACOG, a and William H. Catherino, MD, PhD b Seattle, Wash, and Bethesda, Md OBJECTIVE: A 7.5-MHz finger-grip probe was used to monitor intra-abdominal reproductive surgery in two groups of patients. STUDY DESIGN: The first group of patients underwent transabdominal myomectomy for multiple uterine leiomyomas (n = 3) and the second group underwent uterine reconstruction and excision of obstructive uter- ine horn (n = 3). Intraoperative real-time imaging was accomplished by direct application of the finger-grip probe to the uterine serosa by using saline solution as a transmission media. Ultrasound imaging and surgi- cal dissection were carried out both sequentially and simultaneously. RESULTS: In the first group of patients, the finger-grip probe provided precise location of the leiomyomas and intraoperative guidance for dissection during the myomectomy.In the second group of patients, the fin- ger probe provided images of intrauterine anatomy in one patient who had a normal-sized and normal- shaped uterus with an obstructed intracavitary horn and hematometrium. In two other patients, the obstructed uterine horn extended deep into the pelvis lateral to the vagina. Real-time imaging provided intra- operative monitoring of depth of dissection into the paravaginal space. CONCLUSION: The finger-grip probe demonstrated intrauterine anatomy and enabled a more directed sur- gical approach, both in placement of uterine incisions for surgical reconstruction and excision of obstructed horns for mullerian abnormalities and in identification and dissection for leiomyomas. (Am J Obstet Gynecol 2002;187:1588-90.) Key words: Image-guided surgery, intraoperative ultrasound, mullerian abnormalities, leiomyoma