Minimally invasive exploration of the female reproductive tract in infertility.
Classically, invasive and non-invasive tests are performed to evaluate the causes of infertility. Transvaginal hydrolaparoscopy (THL) allows the exploration of the pelvic structures with a mini-endoscope, using a vaginal needle-guided trocar introduction technique and saline as a distension medium. A first study on 349 patients demonstrated the feasibility of the procedure and gave a high patient satisfaction. Access to the pouch of Douglas was achieved in 330 patients (94.5%) under local anaesthesia and in an ambulatory environment. The mean pain score measured on a visual analogue scale of 10 was 2.7, comparable to the score of mini-hysteroscopy only and significantly lower than the scores of hysterosalpingography with either metal cannula or balloon catheter. A total of 96% of the patients agreed to repeat the procedure under the same circumstances if required. The diagnostic accuracy of the technique was demonstrated in a prospective study, in which two independent endoscopists explored 10 patients with both THL and standard laparoscopy. The inter-observer agreement for ovarian adhesions was 75% for standard laparoscopy and 90% for THL. In addition, in patients with mild endometriosis, more peri-ovarian adhesions were detected with THL than with standard laparoscopy. A multinational survey to evaluate the risk and outcome of bowel injury during THL registered 24 (0.65%) cases in 3667 procedures. In all cases, the diagnosis was made immediately and the treatment was conservative without complications.
Campo
Rudi
R
Leuven Institute for Fertility and Embryology, Tiensevest 168, 3000 Leuven, Belgium. rd@pophost.eunet.be
Gordts
Stephan
S
Brosens
Ivo
I
D004715:Endometriosis / Q000175:diagnosis; D004724:Endoscopy / Q000191:economics / Q000379:methods*; D005184:Fallopian Tube Diseases / Q000175:diagnosis*; D005186:Fallopian Tube Patency Tests; D005260:Female; D006801:Humans; D007246:Infertility / Q000175:diagnosis*; D007247:Infertility, Female / Q000175:diagnosis; D010535:Laparoscopy / Q000379:methods*; D010049:Ovarian Diseases / Q000175:diagnosis*; D015203:Reproducibility of Results; D000267:Tissue Adhesions; D014621:Vagina / Q000473:pathology*