• Kristina Arion, Tuba Aksoy, Catherine Allaire, Heather Noga, Christina Williams, Mohamed A Bedaiwy, and Paul J Yong.
• Department of Obstetrics and Gynecology, University of British Columbia (Drs. Arion, Aksoy, Allaire, Williams, Bedaiwy, and Yong), Vancouver, British Columbia, Canada; BC Women's Centre for Pelvic Pain and Endometriosis (Drs. Arion, Aksoy, Allaire, Noga, Williams, Bedaiwy, and Yong), Vancouver, British Columbia, Canada.
• J Minim Invasive Gynecol. 2019 Jul 1; 26 (5): 928-934.

Study ObjectiveTo evaluate the point-of-care preoperative transvaginal ultrasound (TVUS) sliding sign in comparison with palpation of a nodule on digital pelvic examination for the prediction of pouch of Douglas (POD) obliteration.DesignAnalysis of data from a prospective data registry (Canadian Task Force classification II-2).SettingA tertiary referral center.PatientsWomen with suspected endometriosis who had preoperative pelvic examination and point-of-care TVUS followed by laparoscopic surgery between August 2015 and December 2016.InterventionsWomen were preoperatively assessed for the prediction of POD obliteration with pelvic examination for a nodule and point-of-care TVUS uterine/cervix sliding sign.Measurements And Main ResultsThe study included 269 women, 15.2% (41/269) of whom had POD obliteration at the time of surgery. A preoperative negative sliding sign had a sensitivity of 73.2% (95% confidence interval, 57.1%-85.8%) and a specificity of 93.9% (95% CI, 89.9%-96.6%) in the prediction of POD obliteration compared with preoperative palpation of a nodule on pelvic examination, which had a sensitivity of 24.4% (95% CI, 12.4%-40.3%) and a specificity of 93.4% (95% CI, 89.4%-96.3%). The difference in sensitivity was statistically significant (McNemar test, p <.001). A negative sliding sign was also associated with longer operating times and more difficult surgery including the need for ureterolysis.ConclusionThe point-of-care TVUS sliding sign showed significantly improved sensitivity compared with palpation of a nodule on pelvic examination for the prediction of POD obliteration. Therefore, the point-of-care TVUS sliding sign improves the preoperative assessment of POD disease and thus may lead to more optimal surgical planning in women with suspected endometriosis.Copyright © 2018 AAGL. Published by Elsevier Inc. All rights reserved.

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