Hysteroscopic fallopian tube recanalization using a flexible guide cannula and hydrophilic guide wire

Abstract

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.

Role of Falloposcopy in the Management of Subfertility

“…There is usually a poor correlation between hysterosalpingographic studies and falloposcopy since falloposcopy gives a more accurate visual status of the tube and with HSG false positives could be as high as 40%. [8][9][10] Eight infertility patients with proximal tubal block by hysterosalpingograph had falloposcopy and patency was established in 9 out of 12 tubes, falloposcopy revealed five tubes with multiple or extensive intratubal lesions that would be unsuitable for unilocular tubal resection with subsequent reanastomosis and recanalization for which five tubes had only minor pathologies, two of which became pregnant and only 2% of the tubes needed tubal surgery. Another randomized controlled study revealed that there is a significant benefit in pregnancy rate when tubes were flushed with oil soluble media and this was supported by falloposcopic procedures.…”

Diagnostic and remedial capability of transcervical falloposcopy in conjunction with laparoscopy

“…In 1849, Smith first used the probe of whalebone for catheterization fallopian tube [13].Falloposcopy, first developed in the 1990, was originally a diagnostic device for direct visualization of the fallopian tube lumen [14]. In recent years, tubal cannulation involves insertion of a guide wire within a fine catheter, guided either via ultrasonography [15], fluoroscopy (selective salpingography) [16][17][18], laparoscopy [19] or hysteroscopy [20]. Alternatively, it can also be performed via falloposcopy, which permits direct visualization inspection of the inside of the fallopian tubes.…”

Successful treatment of infertility in a female Sumatran orangutan Pongo abelii

“…HSG in humans has a high false positive rate for proximal tubal occlusion (Allahbadia et al, 2000;Das, Nardo, & Seif, 2007), and approximately two-thirds of fallopian tubes resected for PTO do not show luminal occlusion (Deaton, Gibson, & Riddick, 1990). It is therefore important not to wrongly diagnose PTO as this could lead to the inappropriate suspension of breeding in a genetically important individual.…”