Transvaginal Hydrolaparoscopy

Michelle Catenacci, M.D.; Jeffrey M. Goldberg, M.D.

Disclosures

Semin Reprod Med. 2011;29(2):95-100. 

In This Article

Abstract and Introduction

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

Introduction

In 1944, Decker and Cherry proposed transvaginal endoscopic evaluation of the female pelvic organs using a rigid scope through a small colpotomy incision.[1] The procedure was performed under general or spinal anesthesia with the patient in the knee-chest position that created a spontaneous pneumoperitoneum when the cul-de-sac was entered. Subsequently termed culdoscopy, it was practiced in the 1940s up to the 1970s when it was abandoned in favor of laparoscopy. Until recently, diagnostic laparoscopy had been an established part of the basic infertility evaluation. It is no longer recommended for the asymptomatic infertile woman with a normal pelvic examination and no history of pelvic infection and/or surgery, due to its invasive nature and low yield.[2] As a result, some patients with correctable pelvic disease go undetected.

Transvaginal hydrolaparoscopy (THL) was first described by Gordts et al in 1998 as a modification of culdoscopy to evaluate the fallopian tubes and ovaries of infertile patients.[3] The procedure is performed in the dorsal lithotomy position and uses fluid to float the bowels out of the pelvis. The posterior uterus, pelvic sidewalls, and adnexae can be evaluated. This not only allows assessment of tubal patency but also gives additional information on diseases in the pelvis that may be contributing to infertility. Thus THL goes beyond the traditional basic evaluation with ultrasonography and hysterosalpingography (HSG) by allowing direct visualization of pelvic structures without the use of laparoscopy. Simple operative procedures can also be performed using this technique.

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