Transvaginal access: a safe technique for tubo-ovarian exploration in infertility? Review of the literature

Abstract

Transvaginal laparoscopy offers an accurate and minimally invasive method for the exploration of the female pelvis in patients with infertility. Access to the pouch of Douglas is gained through a simple needle puncture technique of the posterior fornix using a prewarmed watery solution as the distension medium. A review of recently published papers and our own experience illustrate the safety of the technique. Transvaginal laparoscopy can be considered as one of the first and safest examples of the recent developments in natural orifice transluminal endoscopic surgery (NOTES).

Hybrid NOTES transvaginal cholecystectomy: operative and long-term results after 18 cases

“…As far as colpotomy is concerned, pelvic infections and hernias have been seldom observed, even leaving colpotomy open [30,31]. Fertility disorders have to be considered too [32], and therefore, in our study, recruited women were preferably in menopausal rather than in fertile state. The incidence of dyspareunia following gynaecologic surgery is unclear, involving also psychological factors [33].…”

Natural orifice transluminal endoscopic surgery (NOTES) salpingectomy for ectopic pregnancy: a first series demonstrating how a new surgical technique can be applied in a low-resource setting

“…Transvaginal laparoscopy was initially reported as a safe and minimally invasive diagnostic technique in infertility [6]. NOTES is an emerging field in gynaecology, gastrointestinal surgery and urology.…”

Transvaginal Natural Orifice Transluminal Endoscopic Surgery (Notes): Surgical Technique and Results

“…It uses a minimally invasive transvaginal access to the pelvic organs and generally combines the following diagnostic procedures: hydrolaparoscopy (or hydropelviscopy), tubal patency test with methylene blue, salpingoscopy, micro-salpingoscopy and hysteroscopy. The use of videoscopic instruments inserted by transvaginal route to explore the pelvic peritoneal cavity is feasible and the technique has been applied in thousands of patients with complication rates below 1% (Gordts et al, 2008). Nohuz et al (2006) retrospectively evaluated 229 women with primary or secondary infertility without any condition that would justify a laparoscopy and who could benefit from a fertiloscopy (Figures 3 to 5).…”