Objective To evaluate an innovative and simple procedure of hysteroscopic recanalization of cornual occlusion using a diagnostic hysteroscopic sheath, a Labotect flexible guide cannula and a Terumo hydrophilic guide wire, which were all used under laparoscopic guidance. Design In this prospective study, 17 patients with primary or secondary infertility with proven bilateral cornual blockage were scheduled for a recanalization procedure, between June 1995 and October 1998. Setting University-based teaching hospital and the principal author's private clinic. Subjects and methods We combined hysteroscopic cannulation of the proximal fallopian tube using a Labotect cannula with laparoscopic guidance in 17 patients with proximal tubal obstruction which had been diagnosed by hysterosalpingography and confirmed at laparoscopy. This procedure, in addition to being minimally invasive, also accomplishes the objective of causing minimal trauma to the fallopian tube by virtue of the dual hysteroscopic and laparoscopic guidance. Main outcome measures Successful on-table atraumatic recanalization of blocked fallopian tubes, documented by laparoscopic chromopertubation. Results Hysteroscopic cannulation could be attempted in 30 tubal ostia and was successfully accomplished in 15 cases. The instances in which we could not cannulate the tubal ostia (two patients) were not failures of cannulation but failures to visualize the internal tubal ostia because of thick endometrium. Four of our patients have conceived following this procedure and have delivered at term. Conclusion Hysteroscopic cannulation of the fallopian tube is a safe diagnostic procedure that can be used to identify those patients with true proximal occlusion, and may also serve as a therapeutic procedure in some of these patients. We recommend the use of a depot gonadotrophinreleasing agonist, such as triptorelin, 10±15 days before attempting this procedure, for easy visualization and access to the internal tubal ostia. The relative simplicity of the procedure means a shorter learning curve for clinicians in training and other beginners, and the results can be consistently reproduced as shown by the 15 successful cases in this study.