Systematic use of transvaginal hydrolaparoscopy as a minimally invasive procedure in the exploration of the infertile patient: results and reflections

Abstract

Background: The aim of this study was to evaluate the added value of transvaginal hydrolaparoscopy (THL) in the investigation of the infertile patient. Methods: A retrospective cohort study, based on records from 01/09/2006 to 30/12/2019 was undertaken in a tertiary care infertility centre. THL was performed in 2288 patients. These were patients who were referred for endoscopic exploration of the female pelvis as part of their infertility investigation. In 374 patients with clomiphene-resistant polycystic ovary syndrome (PCOS), ovarian capsule drilling was also performed. The outcome objectives of this study included the evaluation of the added diagnostic value of THL as well as the feasibility and safety of the visual inspection of the female pelvis using this technique. Results: Of the 2288 procedures failed access to the pouch of Douglas occurred in in 23 patients (1%). The complication rate was 0.74%, due to bowel perforations (n= 13) and bleeding (n= 4) requiring laparoscopy. All bowel perforations were treated conservatively, with 6 days of antibiotics, and no further complications occurred. Findings were normal in 49.8% of patients. Endometriosis was diagnosed in 366 patients (15.9%); adhesions were present in 144 patients. Conclusions: THL is a minimally invasive procedure, with a low complication and failure rate, providing an accurate visual exploration of the female pelvis in a one-day hospital setting. When indicated, minimally invasive surgery is possible in the early stages of endometriosis and for ovarian capsule drilling in patients with clomiphene-resistant PCOS.

Is There Still a Place for Surgery in Patients with PCOS? A Review

“…Thirty-two articles were evaluated for eligibility after abstract screening. Finally, 17 studies were included in the study [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Of the 17 articles included in this review, 12 were used to provide an overview of LOD in CC-resistant patients with PCOS [16,17,[19][20][21][22][23][24][25]27,28], with some authors focusing on specific techniques in the laparoscopic field, such as Gjønnaess et al and Van Wely et al, who reported the use of ovarian electrocautery [15,23], and Duleba et al, the laparoscopic ovarian wedge resection using a harmonic scalpel [20].…”

An Overview of Postoperative Intraabdominal Adhesions and Their Role on Female Infertility: A Narrative Review

“…Nevertheless, there have been numerous studies conducted, in order to determine as to whether less invasive methods might also provide useful diagnostic results. Some studies consider transvaginal hydro-laparoscopy, sometimes also called “fertiloscopy”, to be a safer, cheaper, and less invasive diagnostic method for finding pelvic adhesions [ 41 , 42 , 43 ]. In transvaginal hydro-laparoscopy, access to the Douglas pouch and, thus, to the pelvic cavity, is gained, by inserting a single-needle, dilating trocar system through the posterior fornix.…”

“…The number of subtle ovarian adhesions found during transvaginal hydro-laparoscopy significantly exceeded the number of findings during standard laparoscopy (present in 12 vs. 4; absent in 9 vs. 17). Although this study has shown that transvaginal hydro-laparoscopy enables the better assessment of mild ovarian adhesions than that by standard laparoscopy [ 43 ], due to the restricted view, abdominal adhesions cannot be examined using transvaginal hydro-laparoscopy [ 46 ].…”

Tubal flushing with oil-based contrast during transvaginal hydro laparoscopy, a case report

“…KoKs 1 in the form of hysterosalpingography (HSG), is often performed. A previous study showed that a HSG with an oil-based contrast has a positive effect on the natural conception rate, compared to a HSG with water-based contrast (van Rijswijk et al, 2020). Transvaginal hydro laparoscopy (THL) is an alternative procedure to test tubal patency.…”

“…Transvaginal hydro laparoscopy (THL) is an alternative procedure to test tubal patency. The benefit of THL is the possibility to explore the tubo- ovarian structures and the pouch of Douglas, neither evaluated during a HSG ( Gordts et al, 1998 ; Gordts et al, 2021 ). However, during a THL procedure, a water-based medium (methylene blue) is used instead of an oil-based medium, of which no fertility enhancing effect has been shown.…”