Diagnosis and treatment of early-stage endometriosis by Transvaginal Hydro laparoscopy

S Gordts, Patrick Puttemans, P Puttemans, I Segaert, M Valkenburg, Marion Valkenburg, V Schutyser, R Campo, Sy Gordts
Facts, views & vision in ObGyn · 2023 · vol. 15(1) , pp. 45–52 · doi:10.52054/fvvo.15.1.057 · PMID:37010334 · PMC10392117 · W4362469663
article OA: gold CC0 ⤵ 3 in-corpus citations
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Transvaginal hydro laparoscopy diagnosed minimal endometriosis in 16% of infertile patients and allowed treatment via bipolar energy, resulting in a 43.8% pregnancy rate.

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Abstract

BACKGROUND: Transvaginal Hydro Laparoscopy (THL) is known as a minimal invasive procedure allowing endoscopic exploration of the female pelvis. OBJECTIVE: To evaluate the possibilities of the THL as a tool for early diagnosis and treatment of minimal endometriosis. MATERIALS AND METHODS: A retrospective study of a consecutive series of 2288 patients referred for fertility problems to a tertiary centre for reproductive medicine was undertaken. Mean duration of infertility was 23.6 months (SD ±11-48), mean age of patients was 31.25 (SD± 3.8y). With normal findings at clinical and ultrasound examination patients underwent, as part of their fertility exploration, a THL. MAIN OUTCOME MEASURES: Evaluation of feasibility, identified pathology and pregnancy rate. RESULTS: Endometriosis was diagnosed in 365 patients (16%); the localisation was higher on the left side (n=237) than on the right side (n=169). Small endometriomas, with diameters between 0.5 and 2 cm, were present in 24.3% (right side in 31, left side 48 and bilateral 10). These early lesions were characterised by the presence of active endometrial like cells and a pronounced neo-angiogenesis. Destruction of the endometriotic lesions with bipolar energy resulted in an in vivo pregnancy rate (spontaneous/IUI) of 43.8% (CPR after 8 months: spontaneous 57.7%; IUI/AID 29.7%). CONCLUSION: THL allowed in a minimally invasive way an accurate diagnosis of the early stages of peritoneal and ovarian endometriosis with the possibility of offering treatment with minimal damage. WHAT IS NEW?: This is the largest series reporting the usefulness of THL for the diagnosis and treatment of peritoneal and ovarian endometriosis in patients without obviously visible preoperative pelvic pathology.

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endometriosisinfertility

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