ABSTRACT: Women undergoing laparoscopic gynecologic surgery are at high risk of injury during trocar insertion, with most injuries occurring at the umbilical port site. The authors developed the visceral slide test to create a noninvasive, reliable method for detecting adhesions in women with a history of abdominal surgery. Visceral slide refers to an ultrasound finding of intra-abdominal viscera sliding in relation to the abdominal wall during inspiration and exhalation. When significant adhesions are predicted, surgeons can guide port selection or choose instead to perform laparotomy. Finding this test is accurate in the office could help guide preoperative counseling.
The aim of this study was to compare the accuracy of the office visceral slide test for predicting obliterating periumbilical adhesions. Female patients older than 21 years were enrolled who had planned laparoscopic gynecologic surgery for benign disease. All had a history of abdominal or pelvic surgery. Prior to laparoscopic surgery, participants underwent a visceral slide test in the office as well as 2 previously validated tests used in the operating room. When visualized with ultrasonography, the visceral slide was defined as normal (positive test) with movement of the viscera more than 1 cm and as abnormal (negative test) with movement of the viscera less than 1 cm during exaggerated inspiration and exhalation. Each screening test took approximately 2 minutes or less to perform. The accuracy of the tests for predicting periumbilical adhesions was compared with that of diagnostic laparoscopy, the criterion standard.
The study group comprised 70 women who had a median of 2 (range, 1–6) previous abdominal surgeries. Among these women, the median number of previous laparotomies was 0 (range, 0–5), and the median number of previous laparoscopies was 1 (range, 0–6). At laparoscopy, the incidence of obliterating periumbilical adhesions was 8.6% (6/70), and the incidence of any adhesions in the abdomen or pelvis was 25.7% (18/70). The office visceral slide test had a sensitivity of 83.3%, specificity of 100%, positive predictive value of 100%, negative predictive value of 98.5%, and diagnostic accuracy of 98.6%. These values were similar to those of the other 2 tests performed in the operating room.
These data show that the office-based ultrasound test is an accurate predictor of obliterating periumbilical adhesions and can provide important information to guide incision choice and preoperative counseling.
Atlanta Center for Minimally Invasive Surgery and Reproductive Medicine, Atlanta, GA; Department of Obstetrics and Gynecology, Northshore-Long Island Jewish Health Systems, Manhasset, NY; and Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA