Transvaginal hydrolaparoscopy as an outpatient procedure for infertility investigation

A new technique called transvaginal hydrolaparoscopy is described for theexploration of the tubo-ovarian structures in infertile patients withoutobvious pelvic pathology. It aims to be an acceptable alternative todiagnostic laparoscopy, a standard but not innocuous procedure whichinfrequently reveals pathology in the asymptomatic patient. Transvaginalhydrolaparoscopy copy is performed under local anaesthesia using a smalldiameter optic with the patient in the dorsal position. Cavity distensionis achieved with normal saline. Transvaginal hydrolaparoscopy does notprovide the familiar and panoramic view of the pelvis given by laparoscopy,but it does have several advantages. These include accurate and atraumaticinspection of adnexal structures without manipulation, with the opportunityto perform dye hydrotubation and salpingoscopy. The risks of a generalanaesthetic are avoided, and there is less risk of trauma to major vessels.The high patient acceptability makes transvaginal hydrolaparoscopy suitableas an early stage procedure in the investigation of infertility and as arepeat or second look procedure. Minor operative procedures such as biopsyand adhesiolysis can also be performed. In patients with obvious pelvicpathology, diagnostic laparoscopy will obviously remain the procedure ofchoice. Transvaginal hydrolaparoscopy deserves full evaluation of itsaccuracy, risks and benefits before it can be accepted as a new first linetechnique in gynaecological practice.