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PubMed1952

Culdoscopy.

Cul-de-sac puncture for introduction of a culdoscope is easily made with the patient in the knee-chest position. With the use of the instrument, the pelvic organs can be viewed clearly. Culdoscopic examination of 45 patients was carried out. In all cases in which laparotomy was done after the examination, the culdoscopic observations and diagnosis were confirmed. In no case in which tubal pregnancy was present, was the diagnosis missed in culdoscopic examination. Patients were only slightly uncomfortable after the examination. There was no evidence of pelvic peritonitis in any patient, and no pregnant patient aborted as a result of the procedure.

Culdoscopes↗
PubMed2002

Culdoscopy using an optical cannula.

OBJECTIVE: To describe a technique for inserting an endoscope through the posterior vaginal fornix under direct vision using an optical cannula. DESIGN: Prospective case study. SETTING: University Department of Obstetrics & Gynecology. PATIENT(S): Patients with infertility referred for investigation in secondary care. INTERVENTION(S): Insertion of culdoscope using an optical cannula. MAIN OUTCOME MEASURE(S): Successful introduction of the culdoscope. RESULT(S): Sixteen of 20 patients had successful introduction of the optical cannula. There were no reported complications. CONCLUSION(S): Insertion of a culdoscope into the cul-de-sac can be done under visual control and this may reduce the risks of complications associated with blind insertion using a modified Veress needle.

Adult↗
PubMed1976

A comparison of laparoscopy and culdoscopy for internal sterilization.

In recent years, the increased demand for sterilization by women who have achieved their desired family size has emphasized the need to improve both existing methods of tubal occlusion and the means of access to the Fallopian tubes. Utilization of diagnostic instruments such as the laparoscope and culdoscope to perform sterilization minimizes the trauma associated with standard laparotomy and colpotomy and promises to reduce morbidity occurring as a result of sterilization. In order to evaluate and compare the improved techniques of laparoscopy and culdoscopy for elective interval sterilization, 722 women were studied between January and August of 1973 at the Siriraj Hospital in Bangkok. For 279 patients (Group I), sterilization was performed by culdoscopic tubal ligation using a modified Pomeroy technique; for 443 patients (Group II), the procedure used was laparoscopic tubal cauterization and cutting. All procedures were performed using local anesthesia on an outpatient basis. Complication rates and required surgical time were similar for both procedures and compared favorably with rates reported by other investigators. Because of a low incidence of complications and the elimination of the need for general anesthesia and hospitalization, both endoscopic procedures appear to be of particular value in developing countries where hospital facilities and physician time are in short supply.

Adult↗
PubMed1999

Development of flexible culdoscopy.

STUDY OBJECTIVE: To assess correlation between findings at standard laparoscopy and office flexible culdoscopy. DESIGN: Observational study (Canadian Task Force classification II-1). SETTING: University-affiliated hospital. PATIENTS: Eleven women undergoing diagnostic laparoscopy to evaluate infertility. INTERVENTIONS: Microlaparoscopy and flexible culdoscopy. In the first six cases laparoscopy was performed first followed by culdoscopy; in the last five cases the order was reversed. MEASUREMENTS AND MAIN RESULTS: The number of endometriotic implants or adhesions was counted for both operative techniques. The flexible 2.2-mm culdoscope provided a view of the pelvis similar to the laparoscope. Correlation between the procedures was 100%. The flexible scope achieved better visualization than the standard rigid posterior cul-de-sac culdoscope. CONCLUSION: Flexible culdoscopy is a excellent procedure for diagnostic endoscopy. It correlates well with office laparoscopy, requires less anesthesia, and is better tolerated by patients. Several operative procedures are currently being tested through this mode of access.

Culdoscopy↗
PubMed1979

Diagnostic miniculdoscopy preceding laparoscopy when bowel adhesions are suspected.

Suspected bowel adhesions are often considered a relative contraindication to laparoscopy. To attempt preoperative diagnoses of intraabdominal adhesions, miniculdoscopy was performed on ten patients with a miniendoscope. It was possible to establish the presence or absence of adhesions and to determine a safe abdominal trocar insertion site. The laparoscope trocar could be inserted under direct controlled vision with the culdoscope in nine cases, suggesting that this procedure averts bowel adhesions. This technique may be a contribution to safer laparoscopy.

Culdoscopes↗
PubMed1977

Psychological sequelae of sterilization in women in Singapore.

The Chinese in Singapore erroneously believe that there is an association between sterilization and castration. This belief has led to deep-seated fears that sterilization may result in obesity, physical weakness, and impairment of sexual function. Beginning in 1969, Singapore authorities introduced increasingly stronger social policies to help reduce family size. Subsequently, there was a large increase in the number of tubal ligations. It was initially thought that this might result in a high incidence of psychological sequelae. A study of 150 women who had had culdoscopic ligations showed that 6.3 percent were dissatisfied at the end of 2 years. Women with fewer than 4 children and those with fewer than 2 sons tended to be more dissatisfied with sterilization.

Adult↗
PubMedDate not supplied

The history of pregnancies that occur following female sterilization.

Data on 208 pregnancies occurring among 20,749 women following sterilization were collected by the International Fertility Research Program and the histories of these pregnancies from conception to termination were analyzed. In the laparoscopic series, the operator's failure to interrupt the tube by electrocoagulation or a tubal occlusion device was the major reason reported for sterilization failure. In the culdoscopic series, operator error or device deficiency were the major reasons for failure. About three quarters of pregnancies in this study were conceived within the first year following sterilization and were confirmed during the first trimester. The rate of ectopic pregnancy occurring in this series was higher than the rate reported for nonsterilized women and was especially high when electrocoagulation was used.

Abortion, Induced↗
PubMed1980

An epidemiologic study of risk factors associated with pregnancy following female sterilization.

Data on 14,700 female sterilization patients were collected by the International Fertility Research Program (IFRP) from 1972 to 1978 and analyzed to determine risk factors associated with the incidence of pregnancy following sterilization. With a case-control approach, it was found that younger patients (less than or equal to 34 years old) and those who did not lactate after sterilization had a higher risk of becoming pregnant. Patients who were sterilized in the early phases of a service program had a higher risk of pregnancy than those sterilized later. In the laparoscopic series, the relative risk of pregnancy was four times greater in patients who had the prototype spring clip than in patients who had the Falope ring. The relative risk increased to 7.0 when patients who had the prototype spring clip were compared to those who had the Falope ring, electrocoagulation, or the Rocket clip. Patients sterilized by electrocoagulation had a low pregnancy risk, but the risk of an ectopic pregnancy was significantly higher than for those sterilized with mechanical devices. In the culdoscopic series, the tantalum clip had an unacceptable pregnancy risk.

Adult↗
PubMed2005

Transvaginal hydrolaparoscopy, its history and present indication.

The investigation of the infertile couple by hysterosalpingography and laparoscopy is currently a highly debated issue. The purpose of this paper is to review whether transvaginal hydrolaparoscopy (THL), a new culdoscopic approach, in combination with minihysteroscopy and chromopertubation test can be offered as a complete one-stop endoscopic exploration. The technique allows complete endoscopic exploration of the reproductive tract in an office or outpatient setting and has been validated during the past years for its accuracy, safety and patient tolerance. Although further prospective randomized studies are required to prove the superiority and cost-benefit of transvaginal hydrolaparoscopy as diagnostic tool in comparison with hysterosalpingography (HSG) and laparoscopy, the technique can be proposed as a safe first-line investigation predicting the fertility outcome in women.

Journal Article↗
PubMed2002

Culdolaparoscopic oophorectomy with vaginal hysterectomy: an optional minimal-access surgical technique.

BACKGROUND AND PURPOSE: Oophorectomy during vaginal hysterectomy may be difficult or impossible when the ovaries lie high in the pelvis or when adhesions are present. A new technique of culdolaparoscopic oophorectomy during vaginal hysterectomy is described. PATIENTS AND METHODS: After the uterus is removed, a 12-mm cannula is introduced into the culde-sac, and a pneumoperitoneum is created. A 10-mm telescope is inserted through the vaginal port, and, under culdoscopic surveillance, two or three 3-mm abdominal ports are placed. The 10-mm telescope is removed, and a minilaparoscope is introduced through one of the abdominal cannulas. Oophorectomy is performed with a coagulator and scissors introduced via the vaginal port, and the ovaries are extracted through the vaginal cannula. Eight patients with pelvic adhesions found at the time of vaginal hysterectomy underwent culdolaparoscopic oophorectomy. RESULTS: The procedure lasted between 28 minutes and 45 minutes, including adhesiolysis, removal of an enlarged ovary, and a liver biopsy. No complications occurred in any of the patients. CONCLUSION: Culdolaparoscopic oophorectomy is a simple minimal-access surgical technique for removing the ovaries when these are not easily accessible at vaginal hysterectomy.

Culdoscopy↗
PubMed2002

Investigation of the infertile couple: a one-stop outpatient endoscopy-based approach.

Transvaginal hydrolaparoscopy (THL) is a new culdoscopic technique for exploration of the pelvic cavity that takes advantage of micro-endoscopic technology and uses aquaflotation for inspection of the tubo-ovarian structures. In infertility patients, THL is systematically combined with mini-hysteroscopy, chromopertubation, fimbrioscopy and, when indicated, salpingoscopy. Mini-hysteroscopy in combination with the chromopertubation test allows accurate assessment of the uterine cavity and tubal patency. The transvaginal access combined with the aquaflotation during THL facilitates detailed inspection of the tubo-ovarian structures and detection of subtle pelvic disease. This combined transvaginal endoscopic approach allows complete evaluation of the reproductive tract. THL is better tolerated than hysterosalpingography, less invasive than standard laparoscopy, and can be used safely as a first line investigation of the female partner in a one-stop infertility clinic.

Cost-Benefit Analysis↗
PubMedDate not supplied

Physiological and pharmacological aspects of local transfer of substances in the ovarian adnexa in women.

An intimate arrangement between the utero-ovarian vein and the ovarian artery has been found in many species. The anatomical structure suggests the existence of a counter-current system of exchange, and many animal experiments point to a physiological importance of this transfer system. In man, the utero-ovarian vein forms a plexus around the ovarian artery. In-vitro experiments have demonstrated a local transfer of progesterone; in-vivo experiments have proved that krypton and progesterone can be transferred from the utero-ovarian vein to the ovarian artery. The physiological and pharmacological importance of the counter-current system is still under evaluation, and further investigations are needed. It has been suggested that counter-current transfer facilitates local communication between the ovary, Fallopian tube, and uterus. This may be important in a context of luteolysis, follicular selection and maturation, fertilization, and the recognition and maintenance of pregnancy. The pharmacological and therapeutic potential may be limited, as the ovarian adnexa are relatively difficult to access. Instillation of hormones into the uterine lumen will probably induce a higher plasma concentration in the ovarian arterial blood than in peripheral arterial plasma. A culdoscopic or endoscopic approach might permit introduction of long-acting depots in the uterine fundus near the Fallopian tubes and/or ovaries.

Animals↗
PubMed1977

Selection of medical or surgical treatment of endometriosis.

The use of the culdoscope and now the laparoscope has made the accurate diagnosis of endometriosis possible so that each case can be clinically staged. A suggested staging of endometriosis similar to that used for carcinoma of the cervix, i.e., consisting of four stages, is proposed. Surgical or hormonal treatment, or a combination of both, can be chosen on the basis of the stage of the disease. Success of therapy can be determined and compared to results of other investigators using the same staging or classification. The choice and extent of surgical treatment, stage for stage, is discussed. The several hormonal regimens, progestins alone, progestins plus estrogen or danazol, are outlined. Previously reported results in the treatment of endometriosis demonstrated a close correlation between stage of disease and percentage of patients who conceive.

Androgens↗