{"paper_id":"a151f73b-da00-4f4a-b22b-49bac6c741b7","body_text":"IMAGES\nSalpingoscopy in tubal endometriosis\nLudovico Muzii & Riccardo Marana\nReceived: 16 February 2010 / Accepted: 29 March 2010 / Published online: 20 April 2010\n# Springer-V erlag 2010\nKeywords Endometriosis . Fallopian tube .\nFemale infertility . Salpingoscopy\nA 35-year-old woman underwent diagnostic laparoscopy\nfor primary infertility of 3-year duration, without associated\npain symptoms. No ovulatory or male factors of infertility\nwere present. She had previously undergone hysterosalpin-\ngography, which had revealed bilateral tubal patency\n18 months before laparoscopy.\nLaparoscopy revealed endometriosis implants on the\nright tube, with mild peritoneal scarring (Fig. 1). Both tubes\nwere readily patent at blue dye injection. Minimal perito-\nneal endometriosis was present on the ipsilateral posterior\nleaf of the broad ligament and on the ipsilateral ovary.\nThe surgeon faced the decision whether to treat or not\nthe implants visible on the tubal serosa. If, on one side,\nthere is sound scientific evidence that the peritoneal\nendometriosis implants should be treated [ 1], the treatment\nof tubal implants on the other side is not clear cut, being\nthis a rare occurrence. Surgical treatment of implants on the\ntubal serosa, either by excision or ablation, may in fact\ncarry the risk of creating additional scarring and retraction.\nThe surgeon decided to perform intraoperative salpin-\ngoscopy, with a 2.9-mm diagnostic hysteroscope and a\n3.7-mm single-flow diagnostic sheath introduced through\nan accessory port. Salpingoscopy is still routinely used in\nour departments in case of tubal disease, despite the fact\nthat it is not generally included in the evaluation of the\ninfertile couple elsewhere [ 2]. Lately, we have been using\na small-caliber hysteroscope, as in this case, instead of the\noriginal instrumentation for salpingoscopy [ 3], since it is\nmore readily available and does not need dedicated\ninstruments. The endoscopic evaluation of the tube\n(Fig. 2) revealed a normal tubal mucosa (class 1 according\nto Brosens' classification [ 3]), no evidence of endometri-\nosis in the tubal mucosa, and no evidence of stenosis of\nthe tubal wall. It was, therefore, decided to leave the tubal\nendometriosis untreated.\nThree months after surgery, the patient spontaneously\nconceived an intrauterine pregnancy.\nDeclaration of interest The authors report no conflicts of interest. The\nauthors alone are responsible for the content and writing of the paper.\nL. Muzii ( *)\nDepartment of Obstetrics and Gynecology,\nUniversità Campus Bio-Medico,\nVia A del Portillo 21,\n00128 Rome, Italy\ne-mail: l.muzii@unicampus.it\nR. Marana\nDepartment of Obstetrics and Gynecology,\nUniversità Cattolica del Sacro Cuore,\nRome, Italy\nR. Marana\nIstituto Scientifico Internazionale Paolo VI,\nUniversità Cattolica del Sacro Cuore,\nRome, Italy\nGynecol Surg (2011) 8:71 –72\nDOI 10.1007/s10397-010-0583-2\n\nReferences\n1. Jacobson TZ, Barlow DH, Koninckx PR et al (2002) Laparoscopic\nsurgery for subfertility associated with endometriosis. Cochrane\nDatabase Syst Rev (4):CD001398\n2. Marana R, Ferrari S, Astorri AL, Muzii L (2008) Indications to\ntubal reconstructive surgery in the era of IVF. Gynecol Surg\n5:85–91\n3. Brosens IA, Boeckx W, Delattin P (1987) Salpingoscopy: a new\npreoperative diagnostic tool in tubal infertility. Br J Obstet\nGynaecol 94:768 –773\nFig. 2 Salpingoscopy with visualization of the tubal mucosa at the\nlevel of the serosal endometriosis revealed no intraluminal disease\nFig. 1 Endometriosis implants on the tubal serosa as seen at\nlaparoscopy\n72 Gynecol Surg (2011) 8:71 –72","source_license":"CC0","license_restricted":false}