Systematic use of transvaginal hydrolaparoscopy as a minimally invasive procedure in the exploration of the infertile patient: results and reflections

S Gordts, Sy Gordts, P Puttemans, Patrick Puttemans, I Segaert, M Valkenburg, Marion Valkenburg, R Campo
Facts, views & vision in ObGyn · 2021 · vol. 13(2) , pp. 131–140 · doi:10.52054/fvvo.13.2.014 · PMID:34184842 · PMC8291988 · W3175646224
article OA: gold CC0 ⤵ 3 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

Transvaginal hydrolaparoscopy offers a minimally invasive, safe, and accurate method for exploring the female pelvis in infertile patients, with potential for early endometriosis treatment and ovarian drilling in PCOS.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-08 ⓘ

This retrospective cohort study evaluated the diagnostic added value, feasibility, and safety of transvaginal hydrolaparoscopy (THL) in 2288 women undergoing endoscopic exploration for infertility at a tertiary care center (records 2006–2019), with additional ovarian capsule drilling performed in 374 clomiphene-resistant PCOS patients. THL failed to access the pouch of Douglas in 23 cases (1%), and the overall complication rate was 0.74%, with bowel perforations and bleeding; bowel perforations were managed conservatively with antibiotics and no further complications were reported. Nearly half of procedures found no abnormalities (49.8%), and endometriosis was diagnosed in 366 patients (15.9%), with adhesions in 144 patients, leading to the conclusion that THL provided accurate pelvic visualization in a one-day setting. This paper is centrally about endometriosis — it reports endometriosis diagnosis rates obtained via transvaginal hydrolaparoscopy as part of infertility workup and discusses minimally invasive surgery at early stages of endometriosis.

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Abstract

BACKGROUND: The aim of this study was to evaluate the added value of transvaginal hydrolaparoscopy (THL) in the investigation of the infertile patient. METHODS: A retrospective cohort study, based on records from 01/09/2006 to 30/12/2019 was undertaken in a tertiary care infertility centre. THL was performed in 2288 patients. These were patients who were referred for endoscopic exploration of the female pelvis as part of their infertility investigation. In 374 patients with clomiphene-resistant polycystic ovary syndrome (PCOS), ovarian capsule drilling was also performed. The outcome objectives of this study included the evaluation of the added diagnostic value of THL as well as the feasibility and safety of the visual inspection of the female pelvis using this technique. RESULTS: Of the 2288 procedures failed access to the pouch of Douglas occurred in in 23 patients (1%). The complication rate was 0.74%, due to bowel perforations (n= 13) and bleeding (n= 4) requiring laparoscopy. All bowel perforations were treated conservatively, with 6 days of antibiotics, and no further complications occurred. Findings were normal in 49.8% of patients. Endometriosis was diagnosed in 366 patients (15.9%); adhesions were present in 144 patients. CONCLUSIONS: THL is a minimally invasive procedure, with a low complication and failure rate, providing an accurate visual exploration of the female pelvis in a one-day hospital setting. When indicated, minimally invasive surgery is possible in the early stages of endometriosis and for ovarian capsule drilling in patients with clomiphene-resistant PCOS.

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endometriosisinfertility

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