Results of a Prospective Comparative Study of Transvaginal Hydrolaparoscopy and Chromolaparoscopy in the Diagnostics of Infertility

Abstract

Transvaginal hydrolaparoscopy (THL) was evaluated in comparison with the already established chromolaparoscopy in the detection of tubal factors, adhesions as well as endometriosis. 43 infertile patients without previous pelvic operations and with an inconspicuous clinical examination were included in a prospective comparative study of THL and chromolaparoscopy. THL succeeded in 40 patients (93.0%). Both methods showed 100% agreement with regard to tubal factors and adhesions. However, only 72/80 tubes (90.0%) could be portrayed by THL. In contrast to this, THL failed to identify 8 of 10 laparoscopically verified endometrioses (isolated endometriosis of the bladder peritoneum in 2). No complications occurred with THL. THL could be the method of choice for the clarification of mechanical infertility factors in symptom-free patients with no suspicion of pelvic pathologies. Tubal pathologies and/or adhesions (visible during THL) should be indications for laparoscopy. In the case of inconspicuous genitals during THL and a still unfulfilled desire for offspring postoperatively, laparoscopy should be considered in order to exclude the possibility of unidentified endometriosis. Retroflexio uteri should at least be a relative contraindication for THL. Further studies are necessary to evaluate the role of THL in the diagnostic concept of infertility in the future.

Ultrasonographically guided transvaginal hydrolaparoscopy

“…Subperitoneal application of saline occurred in 8.9%, a figure comparable Darai (8) who described a 10% occurrence of rectal or pararectal fluid infusion which resulted in termination of the procedure. We did not however have to abort any procedure because of this, in contrast to all previously published reports (8–12). A retroverted uterus does not either have to be a contraindication for UTHL, nor does bilateral tubal occlusion.…”

Laparoendoscopic single-site and natural orifice surgery in gynecology

“…Assessment of tubal patency has been found to be accurate using the THL technique (38). More specifically, if a complete evaluation of the adnexa can be performed, then THL has been shown to be comparable with traditional laparoscopy for the diagnoses of tubal disease, adhesions, and endometriosis.…”

“…An additional 3 mm extraumbilical port was required in one patient with stage 4 endometriosis. Seven out of 9 patients had previous abdominal surgery of bilateral adnexa is approximately 90% (38,39). In addition to the diagnostic value of THL, other potential treatment modalities have now started to be offered using less invasive technique.…”

“…In addition to the diagnostic value of THL, other potential treatment modalities have now started to be offered using less invasive technique. For example, a recent retrospective study demonstrated the feasibility of ovarian drilling by transvaginal hydrolaparoscopy (38). Transvaginal hydrolaparoscopy procedures are appealing in their minimally invasive nature and low morbidity.…”

Complex one-stop investigation of infertility: transvaginal hydrolaparoscopy

“…According to the data of various authors, access to the pouch of Douglas failed in 4.3-0% cases [1][2][3][4][6][7][8][9][10][11][12][13][14][15]. Complications are expected when the patient has a retroverted uterus or in the presence of ovaries, uterine tubes, leiomyoma, bowel loops or varicose veins in the pouch of Douglas.…”