Page 38 - World Journal of Laparoscopic Surgery

World Journal of Laparoscopic Surgery, May-August 2009;2(2):48-52
Pierre C Lucien Charley Trevant

Role of NOTES in the Diagnosis of

Women Pelvic Pathologies

Pierre C Lucien Charley Trevant
Consultant, Gynecologist, Port-Au-Prince, Haiti

Abstract INTRODUCTION
Standard diagnostic laparoscopy is considered the gold standard to Pelvic inflammatory disease (PID) is a common and costly

investigate pelvic pathologies (tubal pathology, endometriosis, and
adhesions...). It gives a panoramic view of the pelvis. But the condition among women of reproductive age that can lead to

invasiveness of diagnostic laparoscopy has almost eliminated its pure infertility,ectopic pregnancy, and chronic pelvic pain. Patients
diagnostic role from contemporary management of common pelvic often have lower abdominal pain, fever, an elevated blood C-
pathologies. It consequently appears interesting to propose an reactive protein level, and adnexal tenderness, but the clinical

endoscopy diagnostic procedure as powerful as the laparoscopy but diagnosisof PID has serious limitations because the symptoms

less invasive which doesn’t require general anesthesia and full vary in large scale and may be atypical. Gastroenterologic

operative facilities. This is the case of transvaginal hydrolaparoscopy
(THL) which proved its efficiency while being as precise as standard problems, urinary tract infections, and other gynecologic

diagnosis laparoscopy. problems maysimulate PID. Thus, the clinical diagnosis of PID

on the basis of symptoms and signs is often inaccurate. The
Keywords: Laparoscopy, transvaginal hydrolaparoscopy, NOTES,

pelvic pathologies, fertiloscopy, infertility. delay of care increases the risk of long-term complications.
Laparoscopy has long been the standard of reference in the

diagnosis of PID, but it requires general anesthesia. Laparo-
AIMS AND OBJECTIVES

scopyis usually performed in patients with moderate to severe

The aim of the present review is to evaluate the usefulness and pelvic pain. Laparoscopy performed to diagnose PID is an

to establish the diagnostic accuracy of the transvaginal invasiveprocedure and may lead to complications. Endometrial

hydrolaparoscopy as an alternative method to investigate the biopsy is less invasive than laparoscopy, but the results are

woman pelvis in comparison of standard laparoscopy in the not readilyavailable.

samepatient, using different parameters like: patient selection, Transvaginal ultrasonography (US) is a noninvasive

operative technique, operating time, intraoperative and bedside procedure that is routinely performed in patients with

postoperative complications, postoperative pain and amount pelvic pain. Earlier studies have shown that transvaginal US

of narcotic used, time until resumption of diet, postoperative performs wellin the diagnosis of PID when the criteria include

morbidity, hospital stay, cost effectiveness and quality of life thickened fluid-filled tubes. Transvaginal US is superior to

analyses. transabdominal US in the diagnosis of endometrial

abnormalities, pelvic masses,and PID.
One option for the noninvasive diagnosis of PID is magnetic
MATERIAL AND METHODS
resonance (MR) imaging but we don’t have the direct view and
1
A literature search was performed using Google, Yahoo, the same result as in diagnostic laparoscopy (Table 1). It
AltaVista and Highwire press. The following search terms were consequently appears interesting to propose an endoscopy
used: “diagnostic laparoscopy and pelvic pathologies almost diagnostic procedure as powerful as the laparoscopy but less
3000 citations were found. When we have searched “the role of invasive which doesn’t require general anesthesia and full
NOTES in the diagnostic of pelvic pathologies” 0 citation was operative facilities. This is the case of transvaginal
found. Then we’re used the terms of “transvaginal hydro- hydrolaparoscopy (THL) which proved its efficiency while
laparoscopy” more than 20 articles were founded. being as precise as standard diagnosis laparoscopy.
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