Transvaginal hydrolaparoscopy: an advance or a gimmick!

Objective: Transvaginal Hydrolaparoscopy (TVHL) is the recent \nmodification of a well known gynecological procedure culdoscopy used \nfor exploration of the pelvic cavity that takes advantages of \nmicro-endoscopic technology and uses aquafloatation for inspection of \nthe tubo-ovarian structures. This is a case series to evaluate the \nfeasibility, procedure performance and complications of Transvaginal \nHydrolaparoscopy. Materials and Methods: The study was conducted at the \nAinShamsUniversityMaternityHospital in Cairo. Twenty two women were \nincluded in the study being referred for diagnostic fertility \ninvestigation or for performing benign hysteroscopic surgery (e.g., \nmyomectomy, septum resection) for infertility or recurrent miscarriage \nreasons. Transvaginal hydrolaparoscopy was carried out in all \nparticipants under general naesthesia. Results: Entry into the \nperitoneal cavity was successful in 21 out of 22 (95.5%) cases. The \nmean duration of the TVHL procedure was 15.6 ±3.2 minutes with a \ntime range from 12 to 19 minutes. The pelvic inspection was excellent \nin 10 (45.5%), satisfactory in 3(13.6%), unsatisfactory in 7 (31.8%), \nand failed in 2 (9.1%). In 3 women traditional laparoscopy was \nperformed in the same setting. There were no difficulties in inspecting \nthe posterior wall of the uterus and the uterine contour in all women \nwith septate or bicornuate uterus (n=7) to guide the procedure of \nseptum resection. TVHL detected pelvic pathological findings in 12 \n(54%) women (4 endometriosis, 3 polycystic ovaries, 2 peritubal \nadhesions, 3 hydrosalpinx). Tubal patency was tested by transcervical \ndye hydrotubation with methylene blue in 5 (22.7%) cases only (4 of \nthem had normal patent both tubes, 1 case had bilateral tubal \nobstruction). Conclusion: Transvaginal hydrolaparoscopy may allow \nlimited detailed exploration of the tubo-ovarian structure in some \ninfertile patients. The procedure can be combined with hysteroscopy and \ndye hydrotubation. Visualization is restricted to the posterior part of \nthe uterus and can judge the uterine contour effectively. However, the \nwhole pelvic inspection process is inferior to that achieved by \nconventional laparoscopy.