Transvaginal Hydrolaparoscopy

Abstract

Transvaginal hydrolaparoscopy (THL) is a modification of culdoscopy that can be used to evaluate the posterior uterus, pelvic sidewalls, and adnexae. Diagnostic THL can be done in the office under local anesthesia. Combined with diagnostic hysteroscopy and chromotubation, it can replace hysterosalpingography (HSG) as the first-line diagnostic test for the infertile woman. Studies have shown high patient tolerability with less pain reported postprocedure than with HSG. THL has been shown to have a high concordance with HSG for tubal patency, but THL diagnosed more intrauterine abnormalities as well as finding adhesions and endometriosis not visible with HSG. In addition, salpingoscopy may be performed during THL to assess the tubal lumen. THL also has a high concordance rate with laparoscopy when a complete evaluation is accomplished during THL. Complications of THL are uncommon and minor. Finally, operative procedures such as ovarian drilling, coagulation of endometriosis, lysis of adhesions, treatment of ovarian cysts, and salpingostomy may be performed via THL.

Transvaginal Hydrolaparoscopy by Flexible Fiberscope - A Study of Preliminary Cases -

“…HSG has been a routine examination in many infertility centers as it is less costly and less invasive than laparoscopy. However, laparoscopy is superior in detecting peritoneal adhesions and endometriosis as compared with HSG [2,7,8]. In the present study, THLF was used for evaluating tubo-ovarian pathology in infertile women.…”

“…Several reviews have validated the concept of THL in comparison to the gold standard: laparoscopy [10]. In a literature review of 187 patients from six studies including one prospective double-blind trial, a high concordance was found between THL and laparoscopy ranging from 77.8% to 100% [7,8]. In a review of 1516 THL, the rate of failure was 5.4% and these were linked to retroverted uterus and the presence of adhesions [3].…”

“…In a review of 4232 procedures from 10 studies, bowel injuries occurred in 0.61%. In a multicenter study, the incidence of bowel perforation was 0.65% and decreased to 0.25%, after an initial learning experience of 50 THL; 92% of these bowel injuries were managed expectantly without consequences [7][8][9]. In addition to diagnostic THL, the relevance of operative THL has been validated mainly for ovarian drilling for polycystic ovary syndrome.…”

“…In addition to diagnostic THL, the relevance of operative THL has been validated mainly for ovarian drilling for polycystic ovary syndrome. Despite the advantages of THL in terms of cost, reliability as compared to laparoscopy in detecting pelvic abnormalities, and its superiority in detecting subtle lesions, as well as the feasibility of performing it under local anesthesia thereby contributing to the couple's participation, adoption of THL remains relatively low, underlining the need to promote this minimally invasive procedure [1][2][3][4][5][6][7][8].…”

“…Some patients become aware of C. trachomatis infection after experiencing infertility or an ectopic pregnancy. The association between C. trachomatis antibody in the sera of infertile women and tubal subfertility has been well documented [8][9][10][11][12][13][14]. C. trachomatis antibody can be determined at low cost and presents no burden to the patient.…”