Page 40 - World Journal of Laparoscopic Surgery

Pierre C Lucien Charley Trevant

(Mintz, 1987) to allow a dorsal decubitus position, and the fertiloscopy was derived, provides the opportunity to demons-

procedure of transvaginal hydrolaparoscopy (THL) was trate fine periovarian and peritubal adhesions, which are not

8,9
described with abdominal distension with saline and easily detected using transabdominal laparoscopy (Table 5).

exploitation of the newly developed smaller endoscopes This statement could be interpreted to mean that laparoscopy
(Tables 2 and 3). The patients were placed in the dorsolithotomy should no longer be considered as a ‘gold standard’.

position. Following disinfection, a Foley catheter number 8was As a result of these suggestions, it was felt appropriate to
introduced into the bladder and another catheter was introduced review whether laparoscopy should remain the primary

into the uterus. The posterior lip of the cervix was graspedby a diagnostic endoscopic procedure in the routine surgical

tenaculum in order to expose the posterior fornix. Theinsertion assessment of women pelvic.

of the Veress needle was facilitated by a stab incision in the

posterior fornix, 1.5 cm below the cervix. A 3 mm blunt trocar Table 2: Successful evaluation of the pelvis and its structures by
was introduced into the posterior fornix. A 2.7 mm diameter transvaginal hydrolaparoscopy (THL) versus standard laparoscopy 2
semirigid endoscope was used, with an optical angle of 30°.

Normal saline solution (250 ml) was instilled into the pouchof Characteristics Laparoscopy (n = 54) THL (n = 54)
Douglas under gravity. Illumination was provided by a high- Pouch of Douglas 54 (100) 54 (100)

intensity cold-light source (250 W) via a fiber-optic lead. The Posterior wall of the 54 (100) 54/54 (100)

images were viewed on a high-resolution color monitor. uterus and USL

Examination started at the posterior wall of the uterus, and by Tubes and fimbriae 108 (100) 94/108 (87.0)

rotation and deeper insertion of the endoscope, the tubes and Ovaries 108 (100) 97/108 (89.8)
Ovarian fossae
72/108 (66.7)
108 (100)

the ovaries were evaluated.

Evaluation by THL was defined as complete whenthe pouch USL = Uterosacral ligament.

of Douglas, the posterior wall of the uterus, the uterosacral Values in parentheses are percentages.

ligaments (USL), the tubes and the fimbriae, the ovaries from
all sides and fossae were all visible (Table 4). After examination Table 3: Tubal findings by transvaginal hydrolaparoscopy (THL)
2
versus standard laparoscopy
of the whole pelvic cavity, tubal patency was evaluated using
dye injection through the uterine catheter. At the end of the Characteristics Laparoscopy (n = 54) THL (n = 54)
examination the instruments were removed and the posterior Normal 40/54 41/54

fornixwas sutured using 3/0 absorbable suture. All procedures Abnormal (%) 14/54 (25.9) 13/14 (92.9)

were followed by hysteroscopy to evaluate the uterine cavity. Proximal obstruction
The patient is fully conscious. She can follow the procedure • Unilateral 2/54 2/2
on the video screen as it is explained to her and her partner. • Bilateral 1/54 1/1
The transvaginal access with hydrofloatation has the advantage Tubal phimosis
of exposing the tubo-ovarian structures in their natural • Unilateral 3/54 3/3
position. • Bilateral 2/54 2/2
The more global concept of fertiloscopy (which includes Hydrosalpinx

THL as well as salpingoscopy, microsalpingoscopy and • Unilateral 6/54 5/6

hysteroscopy) was introduced in 1998. 12,14 An examinationof • Bilateral 0/54 0
the cul-de-sac (pouch of Douglas) in which the ovaries and Table 4: Evaluation of the endometriosis by transvaginal
their relation to the fimbriae of the fallopian tubes are easily hydrolaparoscopy (THL) versus standard laparoscopy. Most

visualized, was the primary purpose of the investigation, asthis patients had endometriosis lesions in more than one location 2

is where the major event in reproduction, oocyte retrieval by Characteristics Laparoscopy (n = 54) THL (n = 54)
the fimbria, occurs. 7,13
Consequently, fertiloscopy was proposed as an alternative Normal 43/54 48/54

todiagnostic laparoscopy as the primary endoscopic procedure Abnormal (%) 11/54 (20.4) 6/11 (54.6)
Posterior wall of uterus
3/8
8/54

in the routine assessment of an infertile woman. 12,14 Laparo- and/or USL

scopy is currently considered to be the ‘goldstandard’ of pelvic Pouch of Douglas 1/54 1/1

endoscopic procedures as it provides not only a panoramic Ovarian fossa

view of the pelvic and abdominal cavities but also the • Unilateral 4/54 1/4

opportunity to perform extensive surgery. Morerecently, it was • Bilateral 1/54 0/1
4,5

emphasized that transvaginalhydrolaparoscopy, from which
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