The Role of Laparoscopy and Salpingoscopy in the Assessment of the Fallopian Tube

In the field of gynecology, infertility treatment in particular, laparoscopy continues to be the gold standard for the evaluation of mechanical factors affecting the fallopian tubes. However, it cannot be used to directly observe the inner cavity of the fallopian tube. The fallopian tube is more than a passive conduit for gametes and early embryos; it also plays an important role in many reproductive functions such as sperm transport and capacitation, oocyte retrieval and transport, fertilization, and embryo storage. However, there are no reports that relate pregnancy outcomes to conditions inside the fallopian tube. It is, therefore, very important to evaluate the conditions both inside and outside of the fallopian tube. The fallopian tube is easily damaged by an ascending vaginal infection, or by a uterine infection such as Chlamydia. These types of damage result in impaired fallopian tube function, and subsequently cause mechanical factors that contribute to female subfertility (Mol et al., 1997). Hysterosalpingography (HSG) is the most common test used to evaluate the fallopian tube, due to its safety and low cost. Papaioannou et al. stated that HSG is a reliable test for the diagnosis of proximal and distal obstruction, hydrosalpix and peritubal adhesions (Papaioannou et al., 2007). A recent report indicated that laparoscopy was mandatory after abnormal HSG results in the work-up prior to the start of the infertility treatment (Tanahatoe, 2008), but it cannot be used to directly observe the inner cavity of the fallopian tube. Salpingoscopy was originally performed during laparotomy for reconstructive tubal surgery to assess the mucosa of the infundibulium and ampulla. A flexible bronchoscope was initially used to improve the images obtained before the introduction of a dedicated, rigid salpingoscope (Papaioannou et al., 2007). Indeed, many clinicians performed salpingoscopy more than a decade ago, and reported abnormal results inside the fallopian tubes (Puttemans et al., 1987; Heylen et al., 1995; Surry & Surry, 1996; Marana et al., 1999; 2003; Marchino et al., 2001). They mainly focused on infertile patients with hydrosalpinges. They performed salpingoscopy during a laparoscopic procedure to repair hydrosalpinges and release patients’ tubes from them. One report described normal and abnormal mucosal folds inside fallopian tubes that were damaged by hydrosalpinges (Puttemans et al., 1987). Several reports mentioned results from inside fallopian tubes, but they only described the conditions inside of the fallopian tubes. Salpingoscopy requires special equipment and expertise, making it an expensive proposition. Its risk profile is comparable to laparoscopy, since it is performed simultaneously.