Rationale of transvaginal laparoscopy in infertility

However, pioneers of pelvic endoscopy like Raoul Palmer3 in Europe and Edward Diamond4 in the USA continued to promote culdoscopy as the method of choice in at least one special application – the diagnosis of infertility, because it provides a closer, clearer, and more detailed view of the fallopian tubes, ovaries, and surrounding pelvic structures than laparoscopy. In 1978 Diamond4published a personal series of 4000 outpatient procedures of diagnostic culdoscopy in infertility. The results were impressive, the complications mild, and the failure rate was very low. Fimbrial phimosis and perifimbrial adhesions were more readily detected. Endometriosis could be seen on all the surfaces of the ovary, the distal end of the tube, the lateral pelvic wall, the utero-ovarian and uterosacral ligaments, and even in locations revealed with difficulty or not at all by laparoscopy. In particular, culdoscopy revealed the fine, filmy adhesions that are only rarely picked up by laparoscopy but which may be responsible for a significant amount of ovarian and tubal malfunction. Diamond concluded that the use of diagnostic culdoscopy as an outpatient procedure provides a better access for the diagnosis and treatment of infertility, especially when the pathology is not extreme enough to warrant laparoscopy. His advice was that the technique should be returned to gynecologic training programs, and he concluded:True, culdoscopy requires laboriously won special skills, but its advantage to patient and physician are well worth the trouble. Once mastered, culdoscopy equips the gynaecologic endoscopist with a rapid and minimally traumatic outpatient option that supplies rich information not only in the initial diagnosis of infertility but also in circumstances where laparoscopy might be inappropriate.