1
|
Gordts S, Gordts S, Puttemans P, Segaert I, Valkenburg M, Campo R. Systematic use of transvaginal hydrolaparoscopy as a minimally invasive procedure in the exploration of the infertile patient: results and reflections. Facts Views Vis Obgyn 2021; 13:131-140. [PMID: 34184842 PMCID: PMC8291988 DOI: 10.52054/fvvo.13.2.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this study was to evaluate the added value of transvaginal hydrolaparoscopy (THL) in the investigation of the infertile patient. Methods A retrospective cohort study, based on records from 01/09/2006 to 30/12/2019 was undertaken in a tertiary care infertility centre. THL was performed in 2288 patients. These were patients who were referred for endoscopic exploration of the female pelvis as part of their infertility investigation. In 374 patients with clomiphene- resistant polycystic ovary syndrome (PCOS), ovarian capsule drilling was also performed. The outcome objectives of this study included the evaluation of the added diagnostic value of THL as well as the feasibility and safety of the visual inspection of the female pelvis using this technique. Results Of the 2288 procedures failed access to the pouch of Douglas occurred in in 23 patients (1%). The complication rate was 0.74%, due to bowel perforations (n= 13) and bleeding (n= 4) requiring laparoscopy. All bowel perforations were treated conservatively, with 6 days of antibiotics, and no further complications occurred. Findings were normal in 49.8% of patients. Endometriosis was diagnosed in 366 patients (15.9%); adhesions were present in 144 patients. Conclusions THL is a minimally invasive procedure, with a low complication and failure rate, providing an accurate visual exploration of the female pelvis in a one-day hospital setting. When indicated, minimally invasive surgery is possible in the early stages of endometriosis and for ovarian capsule drilling in patients with clomiphene- resistant PCOS.
Collapse
|
2
|
van Kessel M, Tros R, van Kuijk S, Oosterhuis J, Kuchenbecker W, Bongers M, Mol BW, Koks C. Transvaginal hydrolaparoscopy versus hysterosalpingography in the work-up for subfertility: a randomized controlled trial. Reprod Biomed Online 2021; 43:239-245. [PMID: 34253451 DOI: 10.1016/j.rbmo.2021.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/07/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
RESEARCH QUESTION Is transvaginal hydrolaparoscopy (THL) non-inferior to hysterosalpingography (HSG) as a first-line tubal patency test in subfertile women in predicting the chance of conception leading to live birth? DESIGN A multicentre, randomized controlled trial in four teaching hospitals in the Netherlands, which randomized subfertile women scheduled for tubal patency testing to either THL or HSG as a first-line tubal patency test. The primary outcome was conception leading to live birth within 24 months after randomization. RESULTS A total of 149 women were randomized to THL and 151 to HSG. From the intention-to-treat population, 83 women from the THL group (58.5%) conceived and delivered a live born child within 24 months after randomization compared with 82 women (55.4%) in the HSG group (difference 3.0%, 95% CI -8.3 to 14.4). Time to conception leading to live birth was not statistically different between groups. Miscarriage occurred in 16 (11.3%) women in the THL group, versus 20 (13.5%) women in the HSG group (RR = 0.66, 95% CI 0.34 to 1.32, P = 0.237), and multiple pregnancies occurred in 12 (8.4%) women in the THL group compared with 19 (12.8%) women in the HSG group (RR = 0.84, 95% CI 0.46 to 1.55, P = 0.58). Ectopic pregnancy was diagnosed in two women in the HSG group (1.4%) and none in the THL group (P = 0.499). CONCLUSION In a preselected group of subfertile women with a low risk of tubal pathology, use of THL was not inferior to HSG as a first-line test for predicting conception leading to live birth.
Collapse
Affiliation(s)
- Mianne van Kessel
- Department of Obstetrics and Gynecology, Dr Horacio E Oduber Hospital Aruba, Oranjestad, Aruba.
| | - Rachel Tros
- Department of Obstetrics and Gynecology, VU University Medical Center Amsterdam, 1007 MB Amsterdam, the Netherlands
| | - Sander van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jur Oosterhuis
- Oosterhuis, Department of Obstetrics and Gynecology, St Antonius Hospital, 3430 EM Nieuwegein, the Netherlands
| | - Walter Kuchenbecker
- Department of Obstetrics and Gynecology, Isala, 8000 GK Zwolle, the Netherlands
| | - Marlies Bongers
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Department of Obstetrics and Gynecology, Maxima Medical Center, 5500 MB Veldhoven, the Netherlands
| | - Ben Willem Mol
- Monash University, Department of Obstetrics and Gynecology Clayton, Australia
| | - Carolien Koks
- Department of Obstetrics and Gynecology, Maxima Medical Center, 5500 MB Veldhoven, the Netherlands
| |
Collapse
|
3
|
Tros R, van Kessel M, van Kuijk S, Oosterhuis G, Kuchenbecker W, Kwee J, Bongers M, Mol B, Koks C. The capacity of transvaginal hydrolaparoscopy versus hysterosalpingography to diagnose tubal pathology in the work-up of subfertile women, a randomised clinical trial. Eur J Obstet Gynecol Reprod Biol 2019; 236:127-132. [DOI: 10.1016/j.ejogrb.2019.02.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 02/26/2019] [Indexed: 10/27/2022]
|
4
|
The prognostic capacity of transvaginal hydrolaparoscopy to predict non-IVF conception. Reprod Biomed Online 2018; 36:552-559. [DOI: 10.1016/j.rbmo.2018.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 01/14/2018] [Accepted: 01/16/2018] [Indexed: 11/21/2022]
|
5
|
Giampaolino P, Morra I, Della Corte L, Sparice S, Di Carlo C, Nappi C, Bifulco G. Serum anti-Mullerian hormone levels after ovarian drilling for the second-line treatment of polycystic ovary syndrome: a pilot-randomized study comparing laparoscopy and transvaginal hydrolaparoscopy. Gynecol Endocrinol 2017; 33:26-29. [PMID: 27228002 DOI: 10.1080/09513590.2016.1188280] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Aim of the study was to asses and compare serum anti-Mullerian harmone (AMH) levels after laparoscopic ovarian drilling (LOD) and transvaginal hydrolaparoscopy (THL) ovarian drilling in clomifene citrate (CC)-resistant polycystic ovary syndrome (PCOS) patients; secondary outcome was to evaluate postoperative pain to estimate the acceptability of procedures. A total of 246 patients with CC-resistant PCOS were randomized into two groups: 123 underwent LOD and 123 underwent THL ovarian drilling. AMH serum levels were evaluated before and after the procedure; moreover, women were asked to rate pain on a visual analog scale (VAS) from 0 (no pain, perfectly acceptable) to 10 (unbearable pain, completely unacceptable). In both groups, postoperative serum AMH levels were significantly reduced compared to preoperative levels (6.06 ± 1.18 and 5.84 ± 1.16 versus 5.00 ± 1.29 and 4.83 ± 1.10; p < 0.0001). Comparing postoperative serum AMH levels, no statistically significant difference was observed between the two surgical technique. After the procedure, mean pain VAS score was significantly higher for women who underwent LOD ovarian drilling in comparison to THL (3.26 ± 1.1 versus 1.11 ± 0.5; p < 0.0001). In conclusion, THL ovarian drilling is comparable to the LOD in terms of reduction in AMH, but it is preferred by patients in terms of acceptability. These results could support to use of THL ovarian drilling in the treatment of patients with CC- resistant PCOS.
Collapse
Affiliation(s)
| | - Ilaria Morra
- a Department of Obstetrics , Gynecology, and Urology and
| | | | | | | | - Carmine Nappi
- b Department of Public Health , University of Naples "Federico II" , Naples , Italy
| | | |
Collapse
|
6
|
Coenders-Tros R, van Kessel M, Vernooij M, Oosterhuis G, Kuchenbecker W, Mol B, Koks C. Performance of outpatient transvaginal hydrolaparoscopy. Hum Reprod 2016; 31:2285-91. [DOI: 10.1093/humrep/dew161] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 05/20/2016] [Indexed: 01/10/2023] Open
|
7
|
Giampaolino P, Pellicano M, Tommaselli GA, Bifulco G, Simioli S, Nappi C, Di Carlo C. In-office transvaginal hydrolaparoscopy: a step-by-step, intraoperative pain evaluation. Arch Gynecol Obstet 2015; 292:1373-7. [DOI: 10.1007/s00404-015-3750-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 05/11/2015] [Indexed: 10/23/2022]
|
8
|
Zhang YX, Liu XQ, Du LR, Li GZ, Lu LH, Tian HY, Gao Y, Zhang Y. Clinical analysis of transvaginal hydrolaparoscopy in infertile patients. Eur J Obstet Gynecol Reprod Biol 2014; 182:208-10. [PMID: 25306224 DOI: 10.1016/j.ejogrb.2014.09.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 09/12/2014] [Accepted: 09/17/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the application of transvaginal hydrolaparoscopy for exploration of the pelvic cavity exploration in infertile women. STUDY DESIGN A total of 510 infertile women were included in this study from May 1st, 2009 to April 30, 2012 in the clinic of the Hebei Research Institute for Family Planning. RESULTS In 495 of 510 of the patients (97.06%), a successful operation was achieved at the first puncture. Of these 495 patients, 286 (57.78%) showed bilateral patency. Completely normal tubo-ovarian and pelvic structures were observed only in 79 patients (15.96%): 16 patients (3.23%) had bilateral tube obstruction, 18 (3.64%) had hydrosalpinx, and 8 (1.62%) had fimbrial stenosis. Pelvic abnormalities occurred in 240 patients (44.04%), including bilateral and/or unilateral tubo-ovarian adhesions in 80 patients (16.16%) and 160 (32.32%) found with adhesions in other parts of the pelvic cavity. Pelvic endometriosis was found in 82 patients (16.57%) and 19 (3.84%) had two or more lesions in the pelvic cavity. In addition, 9 cases (1.82%) of ovarian cysts, 7 (1.41%) of bilateral vesicular appendices and 43 cases (6.69%) of a unilateral vesicular appendix were observed. In addition, convoluted tubes such as bent or twisted tubes were found in 4 cases of bilateral fallopian tube occlusion patients (0.81%) and 17 cases of unilateral tubal occlusion patients (3.43%). CONCLUSIONS Transvaginal hydrolaparoscopy is a feasible, safe, and cost-effective microinvasive technique. This technique can be considered as an alternative procedure for evaluating female infertility.
Collapse
Affiliation(s)
- Yi-Xin Zhang
- Hebei Research Institute for Family Planning, Key Laboratory of Family Planning and Health Birth, National Health and Family Planning Commission, Hebei, Shijiazhuang 050071, China
| | - Xiao-Qun Liu
- Hebei Research Institute for Family Planning, Key Laboratory of Family Planning and Health Birth, National Health and Family Planning Commission, Hebei, Shijiazhuang 050071, China.
| | - Li-Rong Du
- Hebei Research Institute for Family Planning, Key Laboratory of Family Planning and Health Birth, National Health and Family Planning Commission, Hebei, Shijiazhuang 050071, China
| | - Guo-Zheng Li
- Hebei Research Institute for Family Planning, Key Laboratory of Family Planning and Health Birth, National Health and Family Planning Commission, Hebei, Shijiazhuang 050071, China
| | - Li-Hua Lu
- Hebei Research Institute for Family Planning, Key Laboratory of Family Planning and Health Birth, National Health and Family Planning Commission, Hebei, Shijiazhuang 050071, China
| | - Hui-Yan Tian
- Hebei Research Institute for Family Planning, Key Laboratory of Family Planning and Health Birth, National Health and Family Planning Commission, Hebei, Shijiazhuang 050071, China
| | - Yu Gao
- Hebei Research Institute for Family Planning, Key Laboratory of Family Planning and Health Birth, National Health and Family Planning Commission, Hebei, Shijiazhuang 050071, China
| | - Yu Zhang
- Hebei Research Institute for Family Planning, Key Laboratory of Family Planning and Health Birth, National Health and Family Planning Commission, Hebei, Shijiazhuang 050071, China
| |
Collapse
|
9
|
Braidy C, Nazac A, Legendre G, Capmas P, Fernandez H. [Comparison of fertiloscopy versus laparoscopy in the exploration of the infertility: analysis of the literature]. ACTA ACUST UNITED AC 2014; 43:488-95. [PMID: 24767305 DOI: 10.1016/j.jgyn.2014.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 03/10/2014] [Accepted: 03/13/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fertiloscopy is a recent technique designed to explore the tubo-ovarian axis in unexplained infertility. It is a simple outpatient technique, allowing to perform operative procedures, but its position relative to laparoscopy is yet to be defined. MATERIAL AND METHODS A thorough and extensive bibliographical search was undertaken to fully embrace the question, challenging Medline at the National Library of Medicine, Cochrane Library, National Guideline Clearinghouse, Health Technology Assessment Database. All the retrieved articles were classified as either descriptive or comparative studies and evaluated on a set of criteria. RESULTS Most of the papers described case series coming from a few teams, focusing mainly on the technical aspect of the procedure, like the access rate to the posterior cul-de-sac, the success rate in visualizing the pelvis, the complications rate (mainly rectal perforation), and its operative performance in drilling ovaries for resistant polycystic ovarian syndrome. Comparative studies numbered six trials. They all followed the same design, fertiloscopy preceding conventional laparoscopy in patients taken as their own control. The concordance rate between the two modalities reaches 80% in terms of tubal pathology, adherences and endometriosis, with an estimated reduction of laparoscopies varying from 40% to 93%. CONCLUSION The current literature shows a concordance between fertiloscopy and conventional laparoscopic findings for certain parameters in cases of tubal pathology, adherences and endometriosis. The relative positions of these two modalities in unexplained infertility still remain elusive.
Collapse
Affiliation(s)
- C Braidy
- Service de gynécologie obstétrique, hôpital Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - A Nazac
- Service de gynécologie obstétrique, hôpital Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - G Legendre
- Service de gynécologie obstétrique, hôpital Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - P Capmas
- Service de gynécologie obstétrique, hôpital Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - H Fernandez
- Service de gynécologie obstétrique, hôpital Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Inserm U1018, 82, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Université Paris-Sud 11, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
| |
Collapse
|
10
|
De Wilde RL, Brosens I. Rationale of first-line endoscopy-based fertility exploration using transvaginal hydrolaparoscopy and minihysteroscopy. Hum Reprod 2012; 27:2247-53. [DOI: 10.1093/humrep/des192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
11
|
Transvaginal laparoscopic surgery for ovarian cysts. Int J Gynaecol Obstet 2012; 117:33-6. [DOI: 10.1016/j.ijgo.2011.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 11/07/2011] [Accepted: 12/20/2011] [Indexed: 12/31/2022]
|
12
|
Escobar PF, Starks D, Fader AN, Catenacci M, Falcone T. Laparoendoscopic single-site and natural orifice surgery in gynecology. Fertil Steril 2010; 94:2497-502. [DOI: 10.1016/j.fertnstert.2010.08.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 07/02/2010] [Accepted: 08/10/2010] [Indexed: 02/03/2023]
|
13
|
Transvaginal access: a safe technique for tubo-ovarian exploration in infertility? Review of the literature. ACTA ACUST UNITED AC 2008. [DOI: 10.1007/s10397-008-0374-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
14
|
Papaioannou S, Afnan M, Jafettas J. Tubal assessment tests: still have not found what we are looking for. Reprod Biomed Online 2007; 15:376-82. [PMID: 17908397 DOI: 10.1016/s1472-6483(10)60361-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Interest in tubal assessment is as old as interest in fertility and infertility. The Fallopian tube is a particularly complex structure and, as such, an ideal method for its clinical assessment is very difficult to obtain. As a result, a number of different methods have been suggested. Some of these methods are more complementary to each other rather than potential substitutes for one another. Some have been used for many years with a clear evidence base for their performance as diagnostic tests. For other, relatively new tests, very little evidence about their performance is available. Research is moving from a purely anatomical approach (are the tubes open or blocked?) to encompassing functional enquiry (are the open tubes functional and, if not, are there interventions with which fertility performance can be improved?). The available evidence, or lack thereof, for the most commonly used tubal assessment tests is reviewed in this paper. Many questions remain, which, despite the increasing success of IVF, will continue to challenge and stimulate specialists and the public, who are interested in ways to maximize spontaneous as opposed to assisted fertility.
Collapse
Affiliation(s)
- Spyros Papaioannou
- Heart of England NHS Foundation Trust, Heartlands Hospital, Bordsley Green East, Bordsley Green, Birmingham B9 5SS, UK.
| | | | | |
Collapse
|