Transvaginal Hydrolaparoscopy

This paper describes transvaginal hydrolaparoscopy (THL), a modification of culdoscopy used to evaluate the posterior uterus, pelvic sidewalls, and adnexae, with diagnostic THL done in the office under local anesthesia and combined with hysteroscopy and chromotubation. It reports that diagnostic THL can replace hysterosalpingography (HSG) as a first-line diagnostic test in infertile women, citing high patient tolerability and high concordance with HSG for tubal patency, while also noting THL can diagnose additional intrauterine abnormalities, adhesions, and endometriosis not visible with HSG. The paper further states that THL has high concordance with laparoscopy when complete evaluation is accomplished and that complications are uncommon and minor, with potential operative procedures including coagulation of endometriosis and lysis of adhesions performed via THL. This paper is centrally about endometriosis — it specifically discusses THL’s ability to detect endometriosis and its use for endometriosis coagulation during the procedure.

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