Laparoscopic Chromopertubation Research Articles

Assessment of Fallopian Tube Fimbria Patency With 4-Dimensional Hysterosalpingo-Contrast Sonography in Infertile Women.

The purpose of this study was to evaluate the performance of 4-dimensional (4D) hysterosalpingo-contrast sonography (HyCoSy) for assessing fallopian tube fimbria patency in infertile women. Seventy-seven infertile female patients with obstruction at the tubal fimbria or partial obstruction with pelvic adhesions were included. All of the patients underwent 4D HyCoSy enhanced by dynamic observation after a flush of normal saline and were followed with laparoscopic chromopertubation using methylene blue within 6 months. The overall accordance between 4D HyCoSy and laparoscopic chromopertubation was 92.9%. The sensitivity and specificity of 4D HyCoSy with laparoscopic chromopertubation as a reference standard were 93.8% and 92.2%, respectively. Four-dimensional HyCoSy can be the preferred method for assessment of tubal fimbria patency and pelvic adhesions surrounding the ovaries, with its advantages of accuracy, noninvasiveness, and a good safety profile.

Can Laparoscopic Chromopertubation with Methylene Blue Dye cause Anaphylactic Reactions like Pulmonary Edema?

Can Laparoscopic Chromopertubation with Methylene Blue Dye cause Anaphylactic Reactions like Pulmonary Edema?

Can Laparoscopic Chromopertubation with Methylene Blue Dye cause Anaphylactic Reactions like Pulmonary Edema?

Can Laparoscopic Chromopertubation with Methylene Blue Dye cause Anaphylactic Reactions like Pulmonary Edema?

Laparoscopic Chromopertubation, Myomectomy with Opening of the Uterine Cavity and Hysteroscopy during the Early Implantation Phase of an Undetected Pregnancy: Delivery of a Child with a Complex Brain Malformation.

A previously infertile woman underwent laparoscopic myomectomy involving opening of the uterine cavity and chromopertubation that showed closed Fallopian tubes during the early implantation stage of an undetected pregnancy. The pregnancy was not terminated, and a child with a complex brain malformation was delivered at 37 weeks of gestation by Cesarean section.

A Comparative Study between Sonosalphingography and Laparoscopic Chromopertubation for Tubal Evaluation

A Comparative Study between Sonosalphingography and Laparoscopic Chromopertubation for Tubal Evaluation

A novel use of vaginoscopic office hysteroscopy for prediction of tubal patency and peristalsis among infertile women: a preliminary study

The objective of this study is to test whether vaginoscopic office hysteroscopy (OH) can predict proximal tubal patency as compared with hysterosalpingography (HSG) and diagnostic laparoscopy (DL) and concomitantly tubal peristalsis in infertile women. This is a prospective cross sectional study. The setting is in the endoscopy unit of a tertiary hospital. A total of 85 infertile patients scheduled for laparoscopy are used as the sample of this study. The method used is the vaginoscopic OH in the outpatient infertility clinic to assess proximal tubal patency. The patency results will be compared to HSG and DL reports. Diagnostic accuracy of OH alone or in combination with HSG for assessment of proximal tubal patency in comparison to HSG and DL is the mean outcome measure. Office hysteroscopic bubble suction test was feasible in 78 cases (91.7 %). Patent tubes were diagnosed in 91 and 88.5, 92.3 and 91, and 93.6 and 93.6 % using OH, HSG, and DL on right and left sides, respectively. The percentage of agreement between OH and DL was 78 % while it was 84 % between HSG and DL regarding tubal patency testing. Diagnostic indices of OH were very close to those of HSG. Adding OH to HSG did not improve diagnostic accuracy. Positive osteal peristalsis was reported in 32 cases (42 %) and 28 cases (36.8 %) for right and left ostea, respectively. Hysteroscopic bubble suction test is a good initial screening test for tubal patency nearly comparable to HSG and DL. It should be attempted in every case of OH prior to referral for more invasive HSG or laparoscopic chromopertubation test. Hysteroscopic documentation of peristalsis of the proximal part of the tube is an interesting cofinding but requires more confirmatory studies.

A Study Evaluation of Tubal Factors of Infertility by Hysterosalpingography and Diagnostic Laparoscopy

<strong>Background:</strong> Reproductive endocrinologist, consider a couple to be infertile if the couple has not conceived after 12 months of contraceptive free intercourse if the female is under the age of 34 years. The incidence of infertility in any community varies between 10-15 %. Tubal occlusion is one of the most frequent causes of infertility in women (20-40 %). The evaluation of the fallopian tube is necessary to determine the management plan for infertility. The two most diagnostic procedures which are used for the evaluation of tubal patency are hysterosalpingography and laparoscopy<sup>1</sup>. <strong>Aims of this study were:</strong> To study the validity of hysterosalpingography, in detecting tubal factors in infertility, as compared to diagnostic laparoscopy. <strong>Material and Method:</strong> This descriptive study was conducted in the Department of Obstetrics and Gynecology in a tertiary health care center attached to a Medical College. A total number of 114 primary as well as secondary infertility patients were evaluated for tubal factors of infertility. All the infertility cases underwent HSG on day 8<sup>th</sup>, 9<sup>th</sup> and 10<sup>th</sup> day of the menstrual cycles. Laparoscopic chromopertubation was done during proliferative phase of the next menstrual cycle. Statistical analysis was done using statistical package for social sciences ver.18. The result was expressed in mean and standard deviation. "Z" test for the difference between the two means were used. For qualitative data proportion and "Chi" test were used. For assessing the validity of HSG in diagnosing in tubal factors of infertility laparoscopy was used as a gold standard. For the purpose of this study, 95% confidence limit was chosen and corresponding p-value <0.05 was taken as statistically significant. Conclusion: In our study we found that Hysterosalpingography is simple, inexpensive, safe and rapid diagnostic modality for tubal patency then laparoscopy. Laparoscopy is considered the Gold Standard for diagnosing tubal and peritoneal disease. HSG and Laparoscopy are not alternative, but complimentary methods in the examination of tubal patency in case of infertility.

Combined transvaginal sonography and diagnostic hysteroscopy in the assessment of tubal patency in infertile women in correlation to laparoscopic chromopertubation

ObjectiveThe aim of this study was to investigate the diagnostic value of transvaginal sonography (TVS) performed after office hysteroscopy, for assessing tubal patency in subfertile women, and to compare the findings with those obtained with laparoscopic chromopertubation.Study designThis was a cro

Ovarian stripping versus cystectomy: recurrence of endometriosis and pregnancy rate

To compare two different surgical techniques, stripping or cystectomy, in patients treated with the same post-operative medical therapy in terms of recurrence of endometrioma, recurrence of pain and spontaneous pregnancy rate within 2 years from surgery. The inclusion criteria of this study were: (1) 25-40 years old; (2) ovarian endometrioma more than 3 cm of diameter detected by transvaginal ultrasonography (3) regular menstrual cycle (4) post-operative treatment with GnRH analogs, (5) tubal patency assessed by laparoscopic chromopertubation (6) normal human semen characteristics. Exclusion criteria were uterine myoma, previous medical treatment for endometriosis, presence of adenomyosis, previous surgery of ovarian endometrioma, multiple cysts, bilateral involvement, co-existence of deep endometriosis. Patients were assigned to two study groups: group A (N = 45) patients undergoing stripping technique and group B (N = 64) patients undergoing cystectomy technique for ovarian endometrioma. In group B the percentage of ultrasonographic recurrence (15.4 %, N = 15) is much lower than in group A (55.6 %, N = 25). (p value 0.001). In group B the percentage of symptomatic recurrence (21.8 %, N = 14) is much lower than in group A (53.3 %, N = 24) (p value 0.001). Spontaneous pregnancy rate in group A patients was of 4.4 % (N = 2) and in group B 22.3 % (N = 21), (p value 0.0072). However, the percentage of specimen with adjacent healthy ovarian tissue was lower in group A (26.6 %) than in group B (50 %) (p value 0.01). Among the different treatment options for surgical treatment of ovarian endometrioma, in our experience cystectomy appears to be the most appropriate treatment, both in terms of recurrence and pregnancy rate.

Accuracy of Hysteroscopic Versus Laparoscopic Chromopertubation for Assessment of Tubal Patency

Accuracy of Hysteroscopic Versus Laparoscopic Chromopertubation for Assessment of Tubal Patency

The Use of a New Gel Foam for the Evaluation of Tubal Patency

Aims: To evaluate the feasibility and the reliability of hysterosalpingo-foam sonography (HyFoSy) using gel foam in the assessment of tubal patency. Methods: Nonrandomized, observational, academic and single-center study of 20 women being investigated because of subfertility and scheduled for a laparoscopy with chromopertubation. A detailed description of HyFoSy with a newly developed gel foam is given in the way it proved to be most efficient in our hands. The results of HyFoSy are compared to the data regarding tubal patency testing during laparoscopy by chromopertubation. Results: All 20 HyFoSy were technically successful. Four of the 40 tubes, 1 right tube and 3 left tubes, were not patent at HyFoSy (3 tubes with proximal block and 1 tube with distal block). There was a 100% agreement between tubal patency data according to HyFoSy testing and laparoscopic chromopertubation testing. Conclusion: HyFoSy is both feasible and accurate in the diagnosis of tubal patency.

Comparison between transvaginal sonography after diagnostic hysteroscopy and laparoscopic chromopertubation for the assessment of tubal patency in infertile women

Diagnostic hysteroscopy has become a well-established modality for evaluating the uterine cavity, but provides no information regarding tubal patency. The aim of the present study was to investigate the diagnostic value of transvaginal sonography (TVS), performed directly after diagnostic hysteroscopy, for assessing tubal patency in infertile women, and to compare the findings with those obtained by means of laparoscopic chromopertubation. A total of 56 infertile patients were referred to our endoscopic unit for laparoscopic chromopertubation in the period from September 2008 to January 2010. Diagnostic hysteroscopy, followed by TVS, was carried out prior to laparoscopic chromopertubation. The collection of free fluid in the pouch of Douglas was accepted as evidence of tubal patency. The findings of TVS and laparoscopic chromopertubation were compared. The data were analyzed for the sensitivity, specificity, accuracy, positive-predictivevalue, and negative-predictive value of the combination of hysteroscopy and TVS in detecting unilateral or bilateral tubal patency. The presence of fluid in the pouch of Douglas was observed in 37 of the 56 cases. In 36 of these cases, unilateral or bilateral tubal patency was confirmed by laparoscopic chromopertubation. In 17 of the remaining 19 cases (without fluid in the pouch of Douglas during ultrasound), bilateral tubal occlusion was confirmed by laparoscopic chromopertubation. Diagnostic hysteroscopy followed by TVS showed a high sensitivity and specificity for the assessment of tubal patency. TVS performed directly after diagnostic hysteroscopy in infertile patients provides additional nformation regarding tubal patency.

Abdominal abscesses with Streptococcus milleri group after laparoscopic chromopertubation

Sir, Laparoscopic chromopertubation is a basic and safe lement in infertility evaluation (1). Complications of this procedure are uncommon. Vaginal bleeding, mild pelvic pain and vasovagal response have been described. Severe complications such as pulmonary edema, anaphylactic shock and methemoglobinemia are rare (2-4). We wish to call attention to a patient with multiple abdominal abscesses after laparoscopic chromopertubation. A 22-year-old nulligravida underwent laparoscopic chromopertubation as part of an evaluation for primary infertility. Her medical history revealed polycystic ovarian syndrome and morbid obesity. The chromopertubation was uncomplicated and tubal patency was established. Two days after the procedure the patient experienced abdominal pain and fever. A week after chromopertubation she was presented at the Emergency Department with clinical signs of peritonitis. Laboratory data showed leukocytes of 26.3 × 109/L and C-reactive protein of 341 mg/L. Computed tomogram of the abdomen showed an abscess measuring 20 × 10 × 5 cm in the lower abdomen. Laparotomy with drainage of the abscess was performed. Postoperatively she was admitted to the Intensive Care Unit (ICU) with septic shock. The patient was initially treated with cefuroxime (1.5 g three times a day) and metronidazole (500 mg three times a day) and after 2 days piperacillin/tazobactam (4 g/0.5 g three times a day). Cultures of drained material grew Streptococcus milleri group. Pre-procedure cultures revealed no potentially pathogenic flora. The patient deteriorated with respiratory failure. She was transferred to our ICU. A second laparotomy revealed diffuse peritonitis with multiple abscesses which were drained. Despite adequate antibiotic therapy the patient continued to have fever. CT scan revealed another right paracolic abscess that was percutaneously drained. After 22 days the patient was discharged to the surgical ward. Post-procedural infection after chromopertubation is rare. We did not find previous reports. In the case presented here, the reason for the intra-abdominal abscesses most likely was the introduction of Streptococcus milleri in the abdomen via the transcervical injection of methylene blue since Streptococcus milleri is a commensal of the urogenital tract. Introduction via the laparoscopic route is less likely. The Streptococcus milleri group is a heterogeneous complex of streptococci and consists of the species Streptococcus intermedius, Streptococcus constellatus and Streptococcus anginosus. These organisms are not only commensals of the oral cavity, genitourinary tract and gastrointestinal tract, but also notorious causes of pyogenic, invasive infections. Patients with underlying medical conditions, such as cirrhosis, diabetes mellitus and malignancies are predisposed to invasive infections with Streptococcus milleri. Most infections with Streptococcus milleri group organisms respond well to combined surgical and antibiotic treatment but may require multiple procedures and the course can be protracted (5). Although this complication seems to be rare, awareness is of utmost importance because immediate surgical or percutaneous intervention and antibiotic treatment can mitigate the course of the disease and can even be life saving. Patient instruction might have prevented delay in this case.

V52 Ultrasonographic investigation of tubal patency, or laparoscopic chromopertubation

International Journal of Gynecology & ObstetricsVolume 107, Issue S2 p. S411-S411 Video presentations V52 Ultrasonographic investigation of tubal patency, or laparoscopic chromopertubation F. Tamási, F. TamásiSearch for more papers by this authorT. Endrődi, T. EndrődiSearch for more papers by this authorM. Rabóczki, M. RabóczkiSearch for more papers by this authorM. Urban, M. UrbanSearch for more papers by this author F. Tamási, F. TamásiSearch for more papers by this authorT. Endrődi, T. EndrődiSearch for more papers by this authorM. Rabóczki, M. RabóczkiSearch for more papers by this authorM. Urban, M. UrbanSearch for more papers by this author First published: 20 November 2009 https://doi.org/10.1016/S0020-7292(09)61489-2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume107, IssueS2Abstracts of XIX FIGO World Congress of Gynecology and ObstetricsOctober 2009Pages S411-S411 RelatedInformation

Diagnostic Capability of a Laparoscopic Chromopertubation with Monitoring Tubal Perfusion Pressure in Infertile Women

Diagnostic Capability of a Laparoscopic Chromopertubation with Monitoring Tubal Perfusion Pressure in Infertile Women

Ultrasound diagnosis of pathologic changes of the uterine tube

The possibilities of sonographic diagnosis of pathologic changes in the uterine tube are examined by means of a computerised automatic real-time scanner with a statistical B-scan of high resolution. It is not possible to isolate sonographically the anatomically unchanged tube or the tube obliterated as a result of salpingitis. Nevertheless, it is possible to effect an indirect diagnosis if the tube is at least unilaterally patent or if it is bilaterally occluded, by means of an extended form of sonography within the scope of a sonographically controlled hydropertubation via a phenomenon which the author describes an "positive" or "negative" "phenomenon of Douglas". Hence, sonographically monitored hydropertubation, together with hysterosalpingography or laparoscopic chromopertubation--with reservations--is a valuable diagnostic tool to help in clarifying the cause of sterility. Pathological changes of the tubes in the sense of a sactosalpinx of different contents (retained secretions) can be differentiated by sonography. A characteristic sonographic echo pattern is also seen if the tubes are conglutinated with an extremely low amount of liquid collected in the tube. Various pathological changes of the tube can be recognised sonographically directly and indirectly by means of sonography extended in this manner.

Diagnosis of fallopian tube patency

To evaluate and compare the diagnostic value of hysterosalpingography (HSG) and laparoscopic chromopertubation (LCP), in the diagnosis of fallopian tube patency. A comparative prospective study. The infertility clinic of the Department of Obstetrics and Gynaecology, Ga-Rankuwa hospital (Medical University of Southern Africa), Pretoria, South Africa. Fifty patients were initially diagnosed with either unilateral or bilateral tubal block using HSG. Six to eight weeks later the same women were subjected to LCP to assess tubal patency. Diagnostic accuracy of HSG to establish tubal patency, site of occlusion and the presence of other pathologies was compared with results obtained after laparoscopic chromopertubation (LCP). Hysterosalpingography diagnosed bilateral proximal, bilateral distal and mixed (i.e. one side proximal and the other distal) tubal occlusion in 15(40.5%); 13(35.1%) and five (13.5%) cases respectively. Diagnostic laparoscopy confirmed the above sites of occlusion in nine (24.3%), 71(45.9%) and three (8.1%) cases. Laparoscopy detected bilateral tubal patience in three (8.1%) patients, in whom HSG had diagnosed tubal occlusion. USG was able to detect peritubal Adhesion in only four (10.8%) patients as compared with 11 patients when LCP procedure was used. In comparison with HCP, hysterosalpingography demonstrated 70% specificity for accurately diagnosing proximal tubal occlusion. On a comparative scale, HSG demonstrated reduced positive predictive value especially for bilateral proximal tubal occlusion. However, in spite of its relatively limited value for accurately identifying tubal patency, HSG should still serve as a useful primary investigation.

A randomized study of laparoscopic chromopertubation with lipiodol versus saline in infertile women

Eighty-eight infertile patients undergoing laparoscopy were randomized to undergo chromopertubation with lipiodol or with normal saline. The cumulative probability of conception at 1, 3, and 6 months following laparoscopy was not statistically different between the lipiodol group (21%, 31% , and 43%, respectively) and the saline group (18%, 21%, and 33%, respectively).

HYSTEROSALPINGOGRAPHY

Objective: To assess the diagnostic accuracy of Hysterosalpingographyin determining tubal patency in cases of sub fertility. Design: Prospective analytical study. Setting: Department ofGynaecology and obstetric Combined Military Hospital Multan in collaboration with Radiology department. Population:One hundred sub fertile women in their reproductive age having sub-fertility greater than 36 months or less than it, ifmaternal age was greater than thirty years or there was history of pelvic pain or abnormal pelvic findings. Period: May2003 – April 2004. Material & Methods: One hundred patients underwent Hysterosalpingography in follicular phasefollowed by laparoscopic chromopertubation in secretory phase in next cycle. Results: Hysterosalpingography andlaparoscopy were successfully performed in 100% of cases. Full concordant findings from two procedures wereobtained in 80% of cases for tubal blockade. Evaluation of clinical efficacy of Hysterosalpingography regarding tubalpatency showed a sensitivity of 91%, specificity 74.2% with positive predictive value 64.5% and negative predictivevalue 94%. On the other hand a low sensitivity of Hysterosalpingography was obtained regarding peri-tubal adhesions.Both the procedures were free of major complications. Incidence of minor complication was 17% for laparoscopy and18% for Hysterosalpingography. Conclusion: Because of high sensitivity, Positive Predictive Value and reasonablygood concordance rate of Hysterosalpingography with laparoscopy, it should remain an integral part of female subfertilitywork-up. Although it cannot replace laparoscopy but it can be used as first line screening investigation of tubalpatency irrespective of duration of sub-fertility.

Evidence-based diagnosis and management of tubal factor infertility.

The investigation for potential tubal disease is an essential step in the work-up of infertility. This review article provides an evidence-based overview of the diagnosis and management of tubal factor infertility. While laparoscopic chromopertubation remains the gold standard in the diagnosis of tubal disease and hysterosalpingography is still widely used, newer modalities offer some advantages. Sonohysterography with the use of contrast medium is superior to hysterosalpingography and comparable to laparoscopic chromotubation in diagnosing tubal blockage. Chlamydia serology is the most cost-effective and least invasive diagnostic test for tubal disease, and it is comparable to, if not better than, hysterosalpingography. Depending on the nature and degree of tubal dysfunction as well as the age and ovarian reserve of the patient, various treatments for tubal infertility are available. For proximal tubal obstruction, transcervical tubal cannulation with tubal flushing is a reasonable first approach. Surgical techniques for tubal repair, such as salpingostomy or fimbrioplasty for distal tubal obstruction, can provide good results. Still, tubal factor remains a major indication for in-vitro fertilization and embryo transfer, which bypasses the tubal problem altogether. In certain situations, such as the presence of hydrosalpinx, prophylactic surgery can be used in conjunction with in-vitro fertilization and embryo transfer. As with infertility in general, the diagnosis and management of tubal infertility should be tailored to the individual patient. Future studies should help to further clarify the role of the various diagnostic tests and therapeutic approaches for tubal infertility.