Falloposcopic tuboplasty: an easy, quick, and safe technique.

OBJECTIVE: To describe our simplified technique for falloposcopic tuboplasty (FT) and demonstrate its principle and results. DESIGN: A step-by-step description of the technique and demonstration of its principle using a clay model. SETTING: Private infertility clinics in Osaka and Tokyo operated by 10 physicians. PATIENT(S): A total of 431 infertile women with a diagnosis of unilateral or bilateral proximal tubal occlusion (6 cm from the uterotubal ostia), between October 2013 and February 2019 were included. These patients underwent routine work-ups for infertility, including a semen analysis, hysterosalpingography, antimüllerian hormone, basal luteinizing hormone/follicle-stimulating hormone and prolactin concentrations during menstruation, postcoital test in the periovulatory period, and estradiol and progesterone concentrations in the middle of the luteal phase. Physicians performed hysterosalpingography to evaluate tubal patency and uterine shape. Saline infusion sonography was not conducted because it does not accurately identify regions of tubal occlusion and/or stenosis. INTERVENTION(S): The principle of our simplified technique for FT is that a hole is located at the side of the FT catheter tip. Therefore, the balloon and fiberscope move away from the catheter line (Fig. 1). The uterotubal ostium is located at the tip-end of the triangle of the uterine cavity. When a balloon is inserted while visualizing the uterotubal ostium at the nearest position to the ostium, the balloon hits the uterine wall. When a balloon is inserted 5-10 mm from the uterotubal ostium without visualization, the balloon may be easily placed in the ostium through its convex angle, allowing it to slide into the uterine wall (Figs. 2 and 3). Step 1: Confirm anteflexion or retroflexion of the uterus by ultrasound. Step 2: Confirm the direction of the uterotubal ostia by hysteroscopy. Step 3: Adjust the angle of the FT catheter according to steps 1 and 2, insert the catheter into the end of the uterus, pull it back 5-10 mm (without visualizing the uterotubal ostia), and then fix it to the forceps. Catheter placement away from the tubal ostium is confirmed by the residual length of the moving part of the catheter. An attending instructor should ask the operator about the feeling of rigidity when the catheter does not advance and then suggest whether to proceed or stop. In the latter case, the catheter is not moved, saline is infused for 1 minute for lubrication, the balloon is pulled back using the fiberscope to remove the bunching of the balloon, and balloon pressure is changed as follows: 6→8→6→10→6 mmHg. Our institutional review board stated that approval was not required because the video describes the technique of our routine procedure. MAIN OUTCOME MEASURE(S): A description of the FT technique using a clay model and a demonstration of its application in our clinic. RESULT(S): The average operative time was 15.4 minutes, and the clinical pregnancy rate was 24.4% (natural conception and intrauterine insemination without in vitro fertilization). No significant differences were observed in the operative time or pregnancy rate among physicians. Approximately 17 FT procedures may be performed using one fiberscope. CONCLUSION(S): Our simplified technique, which was described and demonstrated in this video article, is a feasible and practical approach for performing FT. It provides excellent cost performance by saving fiberscopes. The most important point is "Introduce the balloon and fiberscope 5-10 mm away from the uterotubal ostia without visualizing it." To facilitate learning this technique, we recommend watching the video and then practicing FT without searching for the uterotubal ostia. Physicians master FT without any assistance by an attending instructor in ≤3 attempts.

Hysteroscopic Assessment of Tubal Patency: A Randomized Comparison between the Flow and Parryscope Techniques.

STUDY OBJECTIVE: To evaluate the accuracy of the "Parryscope" and "flow" techniques for hysteroscopic assessment of tubal patency. DESIGN: Prospective randomized clinical trial. SETTING: From May to October 2019, women with subfertility undergoing laparoscopic and hysteroscopic surgery at the Medical University of Vienna were invited to participate in the study. The primary outcome was accuracy of Fallopian tube patency relative to the gold standard of laparoscopic chromopertubation. PATIENTS: Sixty women with subfertility. INTERVENTIONS: Hysteroscopy with either the "Parryscope" or the "flow" techniques for tubal assessment, directly followed by laparoscopy with chromopertubation. MEASUREMENTS AND MAIN RESULTS: Hysteroscopic prediction of fallopian tube patency was possible in a statistically significant manner in both study groups (p <0.05). The Parryscope technique achieved higher sensitivity (90.6%, 95% CI: 61.7-98.4) and specificity (100%, 95% CI: 90.0-100.0) than the flow technique (sensitivity: 73.7%, 95% CI: 48.8-90.9 and specificity: 70.7%, 95% CI: 54.5-83.9). CONCLUSION: Using the Parryscope technique to determine if air bubbles traverse the ostia can provide valuable additional information during hysteroscopy and is more accurate in predicting fallopian tubal occlusion than the flow method.

Performing the Parryscope technique gently for office tubal patency assessment.

OBJECTIVE: To demonstrate a novel approach to office tubal patency assessment through infusing air into saline during flexible office hysteroscopy. We also provide data addressing pain and patient experience relative to hysterosalpingography (HSG). DESIGN: Video presentation of clinical technique with supportive crossover data (Canadian Task Force classification II-1). Its University of Mississippi Medical Center Institutional Review Board protocol number is 2013-0230. SETTING: Academic hospital. PATIENT(S): Women undergoing office hysteroscopy and ultrasound, with a subset also having HSG. INTERVENTION(S): Air infusion into saline during office hysteroscopy. MAIN OUTCOME MEASURE(S): The focus is on demonstrating how the technique appears and is performed, with supplemental Likert data addressing subjective pain and preference relative to HSG. RESULT(S): When performed as described, this office technique has 98.3%-100% sensitivity to tubal occlusion and 83.7% specificity. The gentle technique is central to accurate outcomes, which is facilitated through use of a small-caliber (<3 mm), flexible hysteroscope and avoiding uterine overdistention. Patients are far more likely to report maximum discomfort with HSG. Among patients who also had HSG, 92% somewhat or strongly prefer hysteroscopic assessment. Also, 96% of patients reporting maximum discomfort with HSG had mild to no discomfort with the described technique. CONCLUSION(S): Air-infused saline at flexible office hysteroscopy can accurately, gently, and rapidly assess tubal patency. Coupled with strong patient preference for this technique over HSG, it is a promising option for evaluating fertility. CLINICAL TRAIL REGISTRATION NUMBER: NCT02005263.

Uterine rupture after balloon inflation of the intrauterine Foley catheter during laparoscopic chromopertubation.

Laparoscopic chromopertubation is considered "gold standard" for checking the tubal patency. Foley catheter is frequently used for blue dye during chromopertubation. Complications associated with the intra-uterine use of Foley catheter are infrequent. The mean normal capacity of the uterine cavity is about 9 ml, and an inflation of up to 30 ml (e. g. during thermal balloon ablation procedures) is considered safe. We report a uterine rupture in a 36-year-old woman undergoing laparoscopic chromopertubation due to primary infertility. Thirteen years ago, the patient had three consecutive laparotomies because of appendicitis, peritonitis and retroperitoneal abscess. For the present laparoscopy, the Foley catheter (Nelaton, charier 10, balloon 5 ml) was used. The first blocking of the balloon with 3.5 ml saline was insufficient; however after inflating with 5 ml, a rupture of the uterine fundus occurred. The balloon remained intact and both tubes appeared patent. The myometrium was sutured and the postoperative course was uneventful. We presume that-in the present case-the expansive capacity of the uterine wall may have been reduced after the series of severe pelvic inflammations. Nevertheless, if using a Foley catheter for the chromopertubation, the optimal pressure for its intrauterine fixation needs still to be determined.

Transvaginal hydrolaparoscopy for diagnosis of tubal infertility.

OBJECTIVE: Infertility problem affects more than 70 million couples worldwide, 5-15% of which are couples in their reproductive age. Less and less invasive endoscopic methods like transvaginal hydrolaparoscopy have been developed by technological progress. This method enables not only precise identification, but is now increasingly used for treatment of tubal and peritoneal factor pathology, which cause approximately 35 per cent of female infertility. AIM: Evaluation of transvaginal hydrolaparoscopy (HLTV) usefulness for diagnosis of tubal infertility comparing to standard laparoscopy and hysterosalpingography (HSG). RESULTS: In evaluation of patent fallopian tubes results of HLTV and HSG examinations are coincide in 87%, while obstruction diagnosed in HSG is confirmed only in 37% during HLTV examination. Transvaginal hydrolaparoscopy and HSG have similar sensitivity and specificity in diagnosis of hydrosalpinx, which is up to 100% . In comparison with HLTV histerosalpingography is less effective in evaluation of peritubal dilatations and adhesions. Both laparoscopic surgery and transvaginal laparoscopy have the same high sensitivity in diagnostics of the fallopian tubes patency and hydrosalpinx, which is up to 100%. In evaluation of peritubal adhesions and dilatations the results are very similar. CONCLUSIONS: 1. HLTV is a highly useful method in evaluation of the fallopian tubes pathologies which is significantly more sensitive than HSG in evaluation of such lesions as peritubal adhesions and obstructed fallopian tubes. 2. HLTV is as effective as laparoscopy in evaluation of patency and lesions of the fallopian tubes. 3. HLTV is a less invasive method, much better tolerated than laparoscopy and more suitable for the group of overweight patients. 4. Final assessment of HTLV technique will be possible following performance of a greater number of studies, where the foregoing conclusions present only initial observations.

Effects of cornual catheterization on uterotubal histology and function.

OBJECTIVE: To assess histologic damage and functional impairment following coaxial tubal catheterization. DESIGN: Prospective randomized controlled study. SETTING: Research laboratory. PATIENT(S): Ninety-two female New Zealand rabbits. INTERVENTION(S): Tubal cannulation and mating. MAIN OUTCOME MEASURE(S): Rabbits randomized for placement of unilateral catheter and guide wire (group 1), unilateral catheter and guide wire plus falloposcope (group 2), and catheterization as in group 1 or 2 but using a cage catheter (groups 3 and 4, respectively). A fifth group consisted of rabbits with tubal perforations. Rabbits were killed at 2 or 4 weeks after catheterization or after mating. The sixth group consisted of only control rabbits. RESULT(S): Only one catheterized tube in groups 1 and 3 showed inflammation, fibrosis, or edema. None of the tubes manifested ciliary loss. Serosal tubal adhesions were identified in two tubes in group 1, in one in group 3, in three tubes in group 5, and one in the control group. The nidation index in control and nonperforated catheterized tubes ranged from 72%-95% (not significant). Nidation index in tubes unintentionally perforated was 81%. CONCLUSION(S): Catheterization of the uterotubal junction and fallopian tube in rabbits does not cause long-term tubal damage or impair tubal function.

[Catheterization of the tubal ostium using hysteroscopy under laparoscopic guidance]. / Cateterización del ostium tubario bajo guía histeroscópica con control laparoscópico.

It is considered that one out of five couples present a transitory problem of infertility during their reproductive life and the most frequent cause is the tubarian pathology; from these, the proximal obstruction occupies between 25 and 30% of the cases. Unfortunatelly, the conventional method use to study tubarian patency such as histerosalpingography or the direct observation by laparoscopy and selective chromotubation, frequently do not allow to differentiate between an insufficient filling of the tubes, tubarian spasm or a true mechanical obstruction. There are certain selective tubarian cannulation techniques, for example, the catheterism with hysteroscopic guidance which is extremely usefull in the diagnosis of tubarian patency or in the confirmation of partial or total proximal tubal disease. The procedure permits to diagnosticate precisely the tubarian obstruction and also if it is due to the presence of a true pathology or simply functional, or secondary to a tubarian spasm; besides it also works as a therapeutic procedure since in the first case permits the lysis of laxe adherencies and the removal of the amorfus material that obstructs the tube and permits the catheterization. The present study determines the utility of catheterization of the tubarian ostium by hysteroscopy with laparoscopic control using the Novy (Cook, Ob/ Gyn) catheter in patients with infertility problems due to proximal obstruction of one or both of the fallopian tubes, to confirm or discard the presence of a pathological obstruction. The results are evaluated in terms of tubarian permeability and the pregnancy rate after the procedure.

[Hysterosalpingosonography by the vaginal route--a new method for assessing uterine tube patency]. / Khisterosalpingosonografiia po vaginalen put--nov metod za otsenka prokhodimostta na matochnite trubi.

UNLABELLED: BUT: Introducing a new sonographic method for evaluation the patency of fallopian tubes. MATERIAL AND METHODS: Transvaginal hysterosalpingosonography (HSSG), using chlorocid as a contrast material was performed in 52 infertile women, 12 of with after ectopic pregnancy. RESULTS: Transvaginal hysterosalpingosonography showed as patent 24 fallopian tubes and 68 obturated. LSC and/or HSG pointed 30 patent and 62 obturated. Compared to LSC and HSG, transvaginal HSSG showed 100% sensitivity and 88% specificity. CONCLUSIONS: This investigation revealed the good diagnostic value of HSSG with chlorocid as an easy and not expensive method for the evaluation of the patency of fallopian tubes.

Microlaparoscopy for suspected pelvic pathology--a comparison of 2mm versus 10mm laparoscope.

This study presents an independently-assessed comparison of the laparoscopic view obtained using a 2mm versus 10mm laparoscope in women with suspected pelvic pathology. Fifteen female volunteers booked for laparoscopy with clinical evidence of pelvic abnormality according to clinical findings and/or pelvic ultrasound were recruited for this study. Sequential observations were carried out by independent observers for clinically significant differences. Although discrepancies were noted in 3 patients the view obtained with the 2mm microendoscope was considered to be comparable to that obtained with the 10mm telescope. The cases with discordant findings included mild or minimal endometriosis and distal tubal disease. The results of this study suggest that microendoscopy is likely to be entirely adequate for many routine laparoscopic procedures and sterilization.

[Tubal catheterization and fallopian tube endoscopy for expanded diagnosis in tubal sterility]. / Tubenkatheterisierung und Falloposkopie zur erweiterten Diagnostik bei tubarer Sterilität.

The present study reports first experiences with falloposcopy for extended diagnosis in tubal sterility. In a total of 38 patients, n = 62 tubes were to be examined falloposcopically. Catheterization was successful in 85.5%. After successful catheterization, optically interpretable images were obtained in 93.6%. The overall success rate was therefore 80%. Considering the anatomical segments of the tube, no differences were found neither for catheterization nor for visualization. The spectrum of intratubal findings extended from normal in 25% to partly obstructive, nodular or non-nodular pictures, together with various degrees of mucosal alteration with or without synechia formation.

Transvaginal sonographic tubal patency testing using air and saline solution as contrast media in a routine infertility clinic setting.

Tubal patency testing by transvaginal sonography has been implemented in our infertility clinic since 1991. We report our experience with this technique during the last year of routine outpatient activity. A total of 154 infertile patients, including three patients on two occasions, underwent tubal patency testing by transvaginal sonography; 36 also underwent laparoscopy or hysterosalpingography, with a further three undergoing both. A detailed account of the method used to visualize the passage of air and saline through the salpinx is described. The 'gold standard' for tubal patency was laparoscopy. In any cases that were doubtful or if there was tubal occlusion, laparoscopy was advised. The diagnoses by transvaginal sonography in the 154 patients consisted of: 106 with bilateral tubal patency (68.8%), 34 with unilateral tubal occlusions (22.1%), and 13 with bilateral occlusion (8.4%); one case was undiagnosed. Tubal disease was present in 25 out of the 36 (69.4%) patients undergoing laparoscopy or hysterosalpingography (69.4%). The sensitivity, specificity, accuracy, positive and negative predictive values were respectively 80, 85, 82.7, 85 and 80% for the 29 patients undergoing transvaginal sonography and laparoscopy. When the number of tubes examined was considered, these values were respectively 85, 91.6, 89.3, 85 and 91.6%. No discordance was observed in the ten patients undergoing hysterosalpingography. Demonstration of the tubal course relies on a positive contrast medium filling the tubal lumen. Air and saline were successful for this purpose. In our study, the results of tubal patency testing by transvaginal sonography were very similar to those of hysterosalpingography, but differed in about 10% of the cases from those of laparoscopy. The most difficult problem to rule out was distal tubal occlusion without hydrosalpinx. Tubal patency testing by transvaginal sonography can be used safely as a first-step examination of tubal patency. Easy tubal passage can allow medical treatment, while a doubtful or frankly occluded salpinx should be investigated by laparoscopy.

[Experience in using kymographic pertubation in the diagnosis and treatment of infertility in a consultation office for women]. / Opyt ispol'zovaniia kimograficheskoi pertubatsii v diagnostike i lechenii besplodiia v usloviiakh zhenskoi konsul'tatsii.

The paper describes the authors' experience in using a [symbol: see text]JITB-01 hysterotubator in the diagnosis of amphora at a women's dispensary from 1991 to 1995. All females who had complaints of being infertile for two years were examined with the hysterotubator. They included 290 females aged 21 to 43 years. Taking into account reexaminations, such studies were 317 altogether. Long-term outcomes could be followed up in 67% of the examinees undergone kymopertubation. Pregnancy occurred in 7% of cases within the first six months after kymoperturbation.

[Experience in using the DLTB-01 hysterotubator for the diagnosis and treatment of tubal infertility]. / Opyt primeneniia gisterotubatora DLTB-01 dlia diagnostiki i lecheniia trubnogo besplodiia.

The paper presents some experience in applying a DLTB-01 hysterotubator to diagnose and treat tubal infertility in females. The patients underwent kymoperturbation from either diagnostic or therapeutical points of view. A hundred seventy eight sessions were performed in 151 females. Analysis of the results of examinations and treatment suggests that the DLTB-01 hysterotubator is beneficial.

A new technique to test tubal patency under transvaginal sonographic control.

OBJECTIVE: Since 1990 we have undertaken a trial to evaluate if TVS, even without contrast media, could diagnose tubal patency. MATERIALS AND METHODS: A detailed description of the technique is given. Two hundred and seventy-three patients underwent sonosalpingography in our department in the period 1990-1993. The sonographic findings were matched in 43 cases to hysterosalpingography and in 55 cases to laparoscopy. RESULTS: Tubal patency was demonstrated in 218 patients (80.5%), monolateral patency in 41 (15.1%) patients and bilateral tubal occlusion in 12 (4.4%) patients. In the 43 patients undergoing hysterosalpingography, discordance between the two examinations was observed in five cases (11.6%). However, only six out of 86 salpinxes had different results (6.9%). In only one case was total discordance observed. In three out of four other cases the difference was due to patency diagnosed at SSG and occlusion at HSG. Of the 55 patients undergoing laparoscopy 12 cases (21.8%) had discordant results. Complete discordance was observed in two cases while in ten cases one salpinx had a different patency report. The discordance goes to 12.7% when we take into account all the salpinxes evaluated. CONCLUSION: Sonosalpingography gives very similar results to hysterosalpingography and may be used on clinical basis for tubal patency evaluation.

[Tuboscopy--an endoscopic approach to the intratubal lumen]. / Die Tuboskopie--Ein endoskopischer Zugang zum intratubalen Raum.

A linear everting catheter in combination with a 0.5-mm microendoscope enables the visualization of the tubal lumen. In 35 sterility patients, diagnostic tuboscopies were performed. Physiological and pathological results of tubal mucosa are described. Tuboscopy is a main tool in the diagnosis of the tubal factor. First steps are taken to use tuboscopy not only for diagnostic but also for therapeutic reasons. Yet, the role of this technique in cases of tubal pregnancies cannot be evaluated.

[Trans-uterine fallopian tube catheterization--a noninvasive, ambulatory evaluation of fallopian tube patency]. / Die transuterine Eileitersondierung--eine wenig invasive, ambulant durchzuführende Uberprüfung der Eileiterdurchgängigkeit.

In a prospective clinical study (March 89-June 91), we examined 114 infertile women to evaluate the diagnostic value of trans-uterine tubal cannulation with the injection of sterile fluid and consecutive sonographical control in the assessment of tubal patency. The results of this technique were compared with the findings of laparoscopy and/or hysterosalpingography. With the Jansen-Anderson Catheter (J-A-C) it was possible to reach the isthmic part of the tube without any analgesia or anaesthesia. 10 to 15 ml of sterile culture medium were injected. In case of tubal patency the fluid was detectable in the pouch of Douglas by transvaginal ultrasound. In 108 out of 114 women (94.7%), the cannulation of at least one tube was possible. All 97 patients with patent tubes (laparoscopy) were diagnosed correctly via the J-A-C. The three cases of proximal tubal occlusion were also diagnosed correctly, 8 patients with one or two-sided hydrosalpinx were also recognized. All five patients with bilateral hydrosalpinx were detected. Three women showed a unilateral hydrosalpinx in the laparoscopy. In these cases the diagnosis obtained by the J-A-C was once bilaterally patent and twice bilaterally distally occluded. Trans-uterine cannulation of the tubes with injection of sterile fluid and consecutive transvaginal sonography is an easy and safe method to evaluate the tubal status. It becomes possible thereby to prove tubal patency in a very early stage of diagnostics. Loss of time and futile treatment cycles (stimulations or inseminations in cases of tubal occlusion) can thus be avoided.

[Tuboscopy--new developments for accurate tubal diagnosis]. / Die Tuboskopie--Neue Entwicklungen für eine exakte Tubendiagnostik.

A specially developed linear everting catheter (LEC) in combination with a microendoscope, enables for the first time the visualisation of the complete tubal mucosa from a vaginal approach. Preliminary results in using this technique are described. Physiological and pathological results of tubal mucosa can be presented, which will influence the diagnostic and therapeutic part of subsequent sterility treatment.

Transcervical tubal cannulation: a review.

Rapid progress has been made in the last 10 years regarding minimally invasive access to the human fallopian tube. Coaxial catheter systems are being used with hysteroscopy, fluoroscopy, ultrasonography, and tactile sensation to cannulate the fallopian tube transcervically with consistent success. Uterotubal obstruction viewed at the time of hysterosalpingogram can often be successfully cannulated with intrauterine pregnancies resulting. This review surveys all available published series of transcervical tubal cannulation with discussion of methodology, success in establishing patency, and the resultant pregnancy rates. It also describes how this technology has been applied to the intratubal deposition of gametes and embryos, direct visualization of the tubal epithelium, (falloposcopy), and contraception. Collectively, these techniques are defining tubal pathology more precisely, allowing us to prescribe the proper therapy.