Laparoscopy in gynaecology.
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Anesthesia↗
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Results for “Fallopian Tube Patency Tests”
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Comparative evaluation of laparoscopy and hysterosalpingography in infertile patients.
A comparative study of hysterosalpingography (HSG) and laparoscopy in the investigation of infertility is presented. From 1973-1977, 352 cases were investigated with both HSG and laparoscopy. In 57.67% of the cases there was complete agreement between HSG and laparoscopy. The study included 168 cases of unexplained infertility and 184 cases with abnormal hysterosalpingographic findings. Pelvic adhesions were demonstrated in 151 cases by laparoscopy as compared to 76 cases in which its presence was only suspected by HSG. Laparoscopy revealed a 57.14% of associated pelvic pathology in cases of unexplained fertility. The present study concludes that laparoscopy as compared to HSG is not only more informative, but also more accurate and conclusive.
Adnexal Diseases↗
[Hysterosalpingography combined with hysteroscopy-laporoscopy in diagnosing female infertility].
OBJECTIVE: To evaluate hysterosalpingography (HSG) combined with hysteroscopy-laparoscopy in diagnosing female infertility. METHODS: One hundred thirty three female infertile patients by clinical diagnosis were given HSG and hysteroscopy-laparoscopy, and the results were retrospectively analyzed. RESULTS: The total diagnostic coincidence rate of the two methods in diagnosing uterus-cervix infertility was 80.2%, while the coincidence rate of the two methods in diagnosing tubal infertility was 89.7%. CONCLUSION: HSG combined with hysteroscopy-laparoscopy is an optimal method in diagnosing female infertility at present.
Adult↗
[Comparison of assessing the patency of the Fallopian tubes during laparoscopy and during hysterosalpingography on television in infertile women with endometriosis].
OBJECTIVES: Sterility become nowadays not only medical, but as well socio-economic problem. One of its major causes is endometriosis. Recurrent adnexitis--one of the most common symptoms of endometriosis might be the cause of fallopian tubes occlusion. The hysterosalpingography (HSG) can be helpful to diagnose this tubal pathology. DESIGN: To compare the assessment of fallopian tubes patency during HSG with the results of laparoscopy in infertile women with endometriosis. MATERIAL AND METHODS: 331 women with endometriosis who were diagnosed during laparoscopy examination between 1998-2002 due to sterility. The presence of endometriosis was confirmed during laparoscopy. In each patient the control of the patency of both fallopian tubes was performed. These data were confirmed with those from HSG performed during follicular phase on the television path. The absence of the contrast passage through fallopian tubes as well as the only trace contrast passage into abdominal cavity were classified as tubal obstruction. RESULTS: In patients during the HSG physiological uterine shape and size in 91.3%, the bicornis uterus in 6.6%, and the unicornis uterus in 2.1% were observed. During laparoscopy we diagnosed the physiological uterine shape and size in 88.8%, the bicornis uterus in 8.2%, and the unicornis uterus in 3.0%. The diagnostic compatibility of these both examinations was 90.6%. In HSG the correct anatomical course of both fallopian tubes without occlusions in 51.7%, the only unilateral patency in 36.7%, and bilateral occlusions in 11.6% were found. During laparoscopy we diagnosed the anatomical course of both fallopian tubes without occlusions in 36.7%, the only unilateral patency in 33.3%, and bilateral occlusions in 30.0%. The diagnostic compatibility of these both examinations was 49.6% for both fallopian tubes, and 34.2% for the only one fallopian tube. In 16.2% both results were incompatible. CONCLUSIONS: The incorrect contrast passage through the fallopian tubes and its increased pressure during HSG in women with the characteristic history and clinical symptoms can suggest endometriosis. In these cases laparoscopy is necessary as the additional examination in the diagnostics of fallopian tubes patency, but the only objective method in diagnosis of endometriosis.
Adult↗
[Sono-hysterosalpingography in the assessment of tubal infertility].
The assessment of the fallopian tubes patency is an important moment in the investigation for infertility. Vaginal sonographic hydrotubation was assessed in the evaluation of uterine configuration and tubal patency. In addition, technique using "agitated" saline during transvaginal sonography was evaluated. Ultrasound was more effective in detecting abnormalities of both interstitial and distal parts of the tube compared with hysterosalpingography. Sonohysterosalpingography is cheaper, may be performed in the office and also the pelvic irradiation is avoided.
Fallopian Tube Diseases↗
Antibodies to Chlamydia trachomatis heat shock protein 60 (cHSP60) and Chlamydia trachomatis major outer membrane protein (MOMP) in women with different tubal status.
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Chaperonin 60↗
The extended Chlamydia trachomatis diagnosis in patients with pelvic inflammatory disease--a better approach for the diagnosis of upper genital tract infections.
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Chaperonin 60↗
[Study on combined transvaginal hydrolaparoscopy and hysteroscopy in patients with infertility].
OBJECTIVE: To evaluate the advantages of combined transvaginal hydrolaparoscopy (THL) and hysteroscopy in patients with infertility. METHODS: Twenty-three primary infertile patients (primary group) and 23 secondary infertile patients (secondary group) were received THL (using a 3-mm scope with a 0 degrees lens) and hysteroscopy. The fallopian tube patency, pelvic pathology, operative time, discharge time, healing time of vaginal wound, success rate of insertion into the pouch of Douglas and intra- and postoperative complications were observed. RESULTS: Primary group had more tube patency cases (P < 0.05) and fewer pelvic adhesion cases (P < 0.05) when compared with secondary group. Only 15.2% patients needed conventional laparoscopy postoperatively. The time of THL, overall time of operation, discharge time, and healing time of vaginal wound were respectively (10.5 +/- 1.7) min, (32.2 +/- 4.6) min, (87.3 +/- 12.5) min, and (4.5 +/- 0.5) days. No complications occurred. CONCLUSIONS: THL is accurate, minimally invasive, safe, economical, and does not require hospitalization. It could serve as a first-line procedure in early stages of infertility investigation when combined with hysteroscopy.
Adult↗
Management of tubal obstructions.
Management of the tubal factor could have the most difficult and debatable role in infertility management. The methods used ranged from gaseous insufflation, hydrotubation, laparotomy, and traditional microsurgery to the more recent tactile or hysteroscopic catheterization, and laparoscopic surgery. Results of the in-vitro-fertilization-embryo transfer (IVF-ET) or intracytoplasmic sperm injection (ICSI) were compared to the surgical procedures' results and the debate continues: shall we proceed directly to assisted reproductive techniques or should surgery be tried first in tubal obstructions?
Drugs, Chinese Herbal↗
[The prognostic value of pre- and postoperative adhesion score and chromopertubation score in sterility operations on the fallopian tubes. 1. Comparison of pre- and postoperative laparoscopic findings].
With 97 female patients who underwent a microsurgical operation of sterility the respectively less damaged tube has been assessed during the diagnostic laparoscopy and during the second-look-laparoscopy with the help of an adhesions-score and a chromopertubation-score. On 92 tubes only one operation was carried out, whereas on five tubes the proximate operation was combined with a distal one. After all methods of operations markedly better adhesions-scores and chromopertubations-scores were achieved. The postoperative adhesions-score was in 79.4% of all cases better than preoperative original value. The chromopertubation-score was postoperatively better in 72.2% of the tubes. 25.8% were macroscopically unobtrusive during the second-look-laparoscopy. After combined distal and proximal operations on one tube favorable postoperative laparoscopic results could be achieved, too.
Adult↗
[The prognostic value of pre- and postoperative adhesion scores (AS) and chromopertubation scores (CPS) in tubal interventions for sterility. 2. Postoperative rate of conception in relation to pre- and postoperative laparoscopy findings in tubal interventions for sterility].
In 97 female patients the respectively less damaged tube has been laparoscopically assessed with the help of on adhesions-score and a chromopertubation-score. The correlation to postoperative fertility has been examined. The rate of conception of patients who underwent a laparoscopic examination was 28.8%. The live birth rate was 17.5%, the rate of spontaneous abortions was 2.1% and the rate of ectopic pregnancies 9.2%. The preoperative adhesions-score doesn't allow prognostical statements, whereas the postoperative adhesions-score closely correlated with the postoperative rate of conceptions. Female patients with a preoperative partial tubal occlusion (CPS = 1) postoperatively chances of conceptions twice as high as female patients with a preoperatively total tubal occlusion (CPS = 2). A postoperative total tubal occlusion (CPS = 2) is a primary indication for in-vitro fertilization.
Adult↗
The intussusception salpingostomy technique for the therapy of distal oviductal occlusion at laparoscopy.
A new technique of salpingostomy by laparoscopy for treatment of distal oviductal occlusion is described. This technique uses sharp dissection and can be performed rapidly. The intussusception salpingostomy is undertaken by making a relatively short incision in the hydrosalpinx and then prolapsing the tubal mucosa through this neostium. The borders of the incision thus act as a restrictive collar to maintain the mucosa in this newly everted configuration. In a series of 40 women subjected to this procedure, 22 were followed for more than 12 months postoperatively; the term pregnancy rate was 22.7%. This fertility is similar to that after salpingostomy by microsurgical laparotomy.
Adult↗
[Experimental and clinical study of tong jing bao and Angelicae complex injection in treating fallopian tube obstruction].
Twenty-two female rabbits with fallopian tube obstruction as the model, were made by 25% Phenol-Tragacanth Mucilage in the laboratory study. Eight rabbits were treated by taking Tong Jing Bao and giving transcervical intrauterine injecting of Angelicae complex injection. Seven were treated with the latter and other seven with 0.9% saline only as the control group. The study showed that in the opening fallopian tube, anti-inflammation, limiting the hyperplasia of fibro-connective tissue and improving the regeneration of epithelial tissue, the first group was more effective than the other two groups (P less than 0.05). Forty-eight infertile women, in whom the fallopian tube obstruction were proved by hysterosalpingography, were divided into two groups for the clinical study. Thirty patients were treated as same as the first group of rabbits. As the control group, other eighteen women were treated with transcervical intrauterine injecting of gentamycin and 0.9% saline in 3 to 6 months. The effective rates were 94.6% and 56.6% (P less than 0.01) and the subsequent pregnancy rates were 46.7% and 27.8% respectively in the different two groups.
Adult↗
Selective fallopian tube canalization.
Infertility is an increasingly common problem. Occlusion of the fallopian tubes is one of the principal causes, and until recently surgery was the only available treatment. The success rate of surgery is often low, particularly with occlusion of the proximal tube. Selective fallopian tube canalization under fluoroscopic guidance has been successful in alleviating proximal tubal obstruction. This procedure may be performed in the outpatient setting and is a safe, cost-effective alternative to surgery.
Adult↗
Surgical management of tubal factor infertility.
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Fallopian Tube Diseases↗
Conservative nonsurgical treatment of early detected tubal pregnancies with intra-amniotic methotrexate.
Four cases of early detected tubal pregnancies were managed conservatively by aspiration and administration of 20 mg methotrexate into the amniotic sac during laparoscopy. All three women for whom hysterosalpingograms are available had patent tubes on the side of the former ectopic pregnancy six months after treatment. Spontaneous menstruation occurred within six weeks after methotrexate application in all cases.
Amnion↗
[Ultrasonic study with hydrotubation of tubal patency].
Ultrasonic study of tubal patency using 1.5% hydrogen peroxide as the contrast medium during hydrotubation was performed in 147 sterile women. Hysterosalpingography was also done for the same patients. In 42 cases, laparoscopic examination of the tubes was carried out to assess the accuracy of the above two diagnostic procedures. The correspondence rate between laparoscopic findings and ultrasonography was 88.0% and 60.0% with hysterosalpingography. The difference was statistically significant (P less than 0.05). Animal experiment did not reveal any untoward effect of 1.5% hydrogen peroxide on the local tissues exposed to the solution except a transient increase of lymphocyte infiltration and exudate. Regardless of its numerous advantages, neither hysterosalpingography nor ultrasonic examination can demonstrate minute pathologic changes in the lumen of the tube. The authors pointed out that ultrasonic study combined with laparoscopic examination is the best choice diagnosis for tubal abnormalities.
Adult↗
Transcervical balloon tuboplasty. A multicenter study.
Transcervical balloon tuboplasty represents a noninvasive technique to treat proximal tubal occlusion. In a multicenter study, 77 women with confirmed bilateral proximal tubal occlusion underwent the procedure. In 71 patients (92%), at least one proximally obstructed fallopian tube was recanalized. Concomitant distal bilateral tubal occlusions were diagnosed after successful proximal tubal balloon recanalizations in 13 patients (17%). In the remaining 64 patients, 22 clinical pregnancies (34%) have been confirmed during a median follow-up period of 12 months. Among those, 17 (77%) resulted in normal deliveries and five (23%) resulted in a first-trimester miscarriage. One patient was diagnosed with an ectopic pregnancy. Among 25 patients who had not conceived within 6 months of the procedure, 17 (68%) demonstrated continuing tubal patency on repeated hysterosalpingogram. We conclude that transcervical balloon tuboplasty is a safe outpatient technique that may represent an alternative to in vitro fertilization or microsurgical reanastomosis of fallopian tubes.
Adult↗