Falloposcopy: Antegrade Imaging in the Management of Oviductal Disease
Salpingoscopy provides excellent views of the outer oviductal lumen, provided the fimbrial end is accessible laparoscopically. Falloposcopy is a less invasive approach through the uterine cavity. The technique is demanding and requires small flexible endoscopes with a reduced field of view and image quality. A recent technologic advance is a cage device that keeps the lumen wall away from the falloposcope lens for continuous antegrade viewing and reduction of white-out. Using a microendoscope designed for falloposcopy and a coaxial delivery system, 150 oviducts were evaluated in 87 women with suspected tubal factor infertility of at least 2 years' duration. Of the 150 oviducts, 40 (27%) were patent and normal, 57 (38%) were patent with mild disease, 17 (11%) were patent with moderate to severe disease, and 36 (24%) were occluded with severe disease. During 15-month follow-up the spontaneous pregnancy rate in women with at least one normal or mildly diseased tube was 23%, and in those with moderate to severe disease was only 6%. After falloposcopy, clinical management was modified based on oviductal findings in 55% of women and confirmed as appropriate in the remainder. The wire cage catheter-delivery system is currently under evaluation and is investigational in the United States. It permits continuous imaging in an antegrade fashion from the uterotubal ostium to the fimbriae or a point of obstruction. This instrument should simplify the technique and improve the diagnostic capabilities of falloposcopy.
Kerin
JF
The University of Adelaide, The Queen Elizabeth Hospital, Woodville Road, Woodville, SA 5911, South Australia.