L26/P-848 A novel translaparoscopic ultrasound-guided technique for oocyte retrieval in patients with inaccessible ovaries: a technical note

Abstract Study question Is translaparoscopic ultrasound-guided oocyte retrieval feasible and safe in patients with inaccessible ovaries? Summary answer Translaparoscopic ultrasound-guided oocyte retrieval appeared to be a feasible and safe approach for oocyte collection in selected patients with inaccessible ovaries, without major complications What is known already Laparoscopic oocyte retrieval is mainly used in patients for whom transvaginal access is contraindicated or considered unsafe, including congenital vaginal agenesis, vaginal or cervical tumors, and cases of ovarian inaccessibility due to anatomical distortion or ovarian fixation. The procedure is conventionally performed under direct visual guidance, which limits the ability to assess the ovarian parenchyma internally and identify residual follicles during oocyte retrieval. Despite being considered feasible and safe, laparoscopic oocyte retrieval remains technically challenging and supported mainly by small case series. To date, translaparoscopic ultrasound-guided oocyte retrieval using a dedicated laparoscopic ultrasound transducer has not been previously described. Study design, size, duration This technical note describes a previously undescribed oocyte retrieval technique based on translaparoscopic ultrasound guidance using a laparoscopic ultrasound transducer typically employed for the evaluation of solid organ lesions. The technique is illustrated by four clinical cases from the initial clinical experience at a single tertiary fertility center between February 2024 and August 2025. Participants/materials, setting, methods Four women aged 30–33 years with cervical cancer and a desire for fertility preservation underwent controlled ovarian stimulation with gonadotropins, followed by translaparoscopic ultrasound-guided oocyte retrieval. Follicular aspiration was performed using a beveled oocyte retrieval needle through a 5-mm trocar, guided by a linear laparoscopic ultrasound transducer inserted through a 12-mm trocar and positioned on the ovarian surface. The transducer features a four-way adjustable head up to 90°, enabling real-time follicular visualization and guided aspiration Main results and the role of chance Bilateral ovarian puncture was successfully performed in all four cases without the need for conversion to an alternative approach. All procedures were performed urgently due to the need to initiate oncologic treatment without delay. The number of oocytes retrieved varied between cases, reflecting individual ovarian characteristics, stimulation response, and procedural complexity. Translaparoscopic ultrasound guidance enabled real-time visualization of ovarian follicles and precise needle placement, including follicles not clearly identifiable under direct laparoscopic vision alone. Follicular aspiration was technically successful in all cases; however, oocyte recovery was not achieved in one patient despite adequate follicular access. Improved procedural performance was observed in the last two cases, likely related to increased operator familiarity with transducer manipulation and optimization of stimulation protocols. No intraoperative or postoperative complications were reported. Due to the descriptive nature of this initial clinical experience and the small sample size, no statistical analysis was performed, and results are presented descriptively without assessment of statistical significance Limitations, reasons for caution This report is limited by its small sample size and descriptive design. Results are based on a single-center experience without a comparator group. The technique requires specific surgical expertise and familiarity with oocyte retrieval procedures and ultrasound imaging. Findings should be interpreted cautiously and cannot be generalized without further studies. Wider implications of the findings Translaparoscopic ultrasound-guided oocyte retrieval may represent a valuable alternative for fertility preservation in patients with inaccessible ovaries. This approach may improve follicular visualization and procedural precision, expanding surgical options in complex clinical scenarios where conventional transvaginal retrieval is not feasible Trial registration number No