Is Reparative Tubo-Ovarian Surgery Obsolete?
With the availability of in vitro fertilization (IVF), reparative tubo-ovarian microsurgery is considered obsolete. In our institutions, salpingectomy has been performed for Mage score 4 and Brosen score 4 to 5 tubal occlusion. The results of reparative laparoscopic tubo-ovarian surgery (stages 1-3) are better for fimbrioplasty than for salpingoneostomy. The best result is for tubolysis and ovariolysis, often associated with fimbrioplasty. The procedure resulted in 27.7% intrauterine pregnancies and less than 10% ectopic pregnancies. The development of thin, atraumatic endoscopes will probably improve these rates and also reduce costs. We reevaluated reparative surgery after the failure of at least three cycles of IVF. With advances in salpingoscopy, the selection of patients improved for lesions of the ampulla. Women undergoing salpingoscopy had bifocal lesions, but also tubal occlusion with an unfavorable prognosis for the procedure's success. In women with hydrosalpinx, salpingectomy is supposed to improve the results of IVF. We reserve reparative and conservative surgery for women with good salpingoscopic score, which is probably one of the reasons for our encouraging results. For the proximal and isthmic part of the tube, the diagnosis remains difficult, despite the promising results of transcervical tuboscopy. The development of thin atraumatic endoscopes will probably continue to improve evaluation of tubal pathology and permit better patient selection for surgery.
Dequesne
JG
Endoscopic Center Clinique Cecil, 16, ch. des Croix-Rouges, CH-1007 Lausanne, Switzerland.
Watrelot
A