Prospective evaluation of the learning curve of fertiloscopy with and without ovarian drilling

Abstract

Fertiloscopy represents an alternative to laparoscopy in the diagnostic evaluation of unexplained infertility or for the purpose of ovarian drilling. The learning curve of fertiloscopy in an experienced laparoscopic surgeon was evaluated in a prospective multicentre observational trial. A total of 110 fertiloscopies were carried out. At Centre 1, a beginner, and at Centre 2, an expert in fertiloscopy, performed the procedures. In three cases in Centre 1, and in 0 cases in Centre 2, the procedure was converted to transabdominal laparoscopy owing to intraoperative complications. Median operating time was longer at Centre 1 during the first 40 procedures (P < 0.001) and equal thereafter. Analyzing fertiloscopies with and without ovarian drilling separately, operating time was only longer for the first 20 procedures in each group (P < 0.001 and P = 0.002). In a multivariate analysis, intraoperative complications and fertiloscopy with ovarian drilling (compared with diagnostic fertiloscopy) were associated with longer duration of surgery (P < 0.001 for both parameters). An increasing consecutive number of fertiloscopies was associated with shorter duration of surgery (P < 0.001). Experienced laparoscopists should consider a transition towards fertiloscopy in the diagnostic workup of unexplained infertility or for the purpose of ovarian drilling.

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

“…Experienced laparoscopists are now being advised to consider a Fig. 1 Conventional, reusable laparoscopic instruments used and inserted through an inexpensive, self-constructed single port device transition towards fertiloscopy in the diagnostic workup of unexplained infertility, or for the purpose of ovarian drilling [12]. vNOTES can also be used as an approach for adnexal surgery and adhaesiolysis [3][4][5]13].…”

Ovarian drilling in polycystic ovary syndrome: Long term pregnancy rate

“…Few complications were noticed [25]; the most frequent (5.4% of cases) was failure of the surgical approach leading to conversion to laparoscopy. Transvaginal hydrolaparoscopy requires a specific learning process with a short learning curve [18,26]. The rate of serous rectal injury was 1% [27].…”