I was pleased to contribute to a new commentary in BJOG, led by Jolanda van Keizerswaard with Mathew Leonardi and Judith Huirne as senior authors, that makes the case for a simple shift in gynaecology: the surgeon should be the one holding the ultrasound probe. Gynaecological surgery and ultrasound have both advanced enormously, yet they remain largely separate skill sets. Surgeons often rely on a written report from someone else to plan complex benign surgery, and that report can’t convey what matters most in the operating room, such as how mobile the organs are, whether adhesions are present, or how structures like the bowel and ureter relate to a lesion. When the operating surgeon performs the scan, they can test organ movement, correlate findings with the patient’s pain, and begin planning the procedure as they image. We describe this as dynamic anatomical intelligence, direct translation into surgical strategy, and embodied knowledge that carries into the operation itself.
The commentary also argues that skilled transvaginal ultrasound should be the foundation of gynaecological assessment, with MRI complementing it rather than leading. The evidence shows that ultrasound can match MRI for conditions such as fibroids, adenomyosis and deep endometriosis, and may even outperform it for ovarian masses. Surgeon-led scanning also benefits patients and health systems, supporting better counselling and informed consent, more realistic theatre scheduling, and earlier referral of complex cases to specialist centres. Sometimes it shows that a conservative pathway is the better choice. Making this a reality will take structural change, including ultrasound training embedded in surgical education, protected time and equipment, and prospective multicentre research on clinical, patient-centred and economic outcomes. The message is in the title: the probe should not merely precede the scalpel, it should guide it. The article is open access, so you can read it in full at doi.org/10.1111/1471-0528.70359.