Transvaginal hydrolaparoscopy: an advance or a gimmick!

Objective: Transvaginal Hydrolaparoscopy (TVHL) is the recent modification of a well known gynecological procedure culdoscopy used for exploration of the pelvic cavity that takes advantages of micro-endoscopic technology and uses aquafloatation for inspection of the tubo-ovarian structures. This is a case series to evaluate the feasibility, procedure performance and complications of Transvaginal Hydrolaparoscopy. Materials and Methods: The study was conducted at the Ain Shams University Maternity Hospital in Cairo. Twenty two women were included in the study being referred for diagnostic fertility investigation or for performing benign hysteroscopic surgery (e.g., myomectomy, septum resection) for infertility or recurrent miscarriage reasons. Transvaginal hydrolaparoscopy was carried out in all participants under general anaesthesia. Results: Entry into the peritoneal cavity was successful in 21 out of 22 (95.5%) cases. The mean duration of the TVHL procedure was 15.6 ±3.2 minutes with a time range from 12 to 19 minutes. The pelvic inspection was excellent in 10 (45.5%), satisfactory in 3(13.6%), unsatisfactory in 7 (31.8%), and failed in 2 (9.1%). In 3 women traditional laparoscopy was performed in the same setting. There were no difficulties in inspecting the posterior wall of the uterus and the uterine contour in all women with septate or bicornuate uterus (n=7) to guide the procedure of septum resection. TVHL detected pelvic pathological findings in 12 (54%) women (4 endometriosis, 3 polycystic ovaries, 2 peritubal adhesions, 3 hydrosalpinx). Tubal patency was tested by transcervical dye hydrotubation with methylene blue in 5 (22.7%) cases only (4 of them had normal patent both tubes, 1 case had bilateral tubal obstruction). Conclusion: Transvaginal hydrolaparoscopy may allow limited detailed exploration of the tubo-ovarian structure in some infertile patients. The procedure can be combined with hysteroscopy and dye hydrotubation. Visualization is restricted to the posterior part of the uterus and can judge the uterine contour effectively. However, the whole pelvic inspection process is inferior to that achieved by conventional laparoscopy.