Laparoscopic Chromopertubation Research Articles

Anaphylactic reaction to methylene blue dye after laparoscopic chromopertubation

A 25-year-old infertile woman was admitted to our department with occluded right Fallopian tube and left sactosalpinx. Diagnostic hysteroscopy (Wolf, Knittlingen, Germany) showed a normal, follicular-phase endometrium with a small endometrial polyp in the uterine fundus. Electroresection of the polyp was performed with no complication or excessive bleeding. After hysteroscopy, a laparoscopic examination was performed (Aesculap, Tuttlingen, Germany). It revealed adenomyosis of the uterus, small patches of pelvic endometriosis, and endometriosis of the right ovary. Electrocoagulation of the right ovarian endometriosis was performed. Chromopertubation with methylene blue (Patenblau V; Guerbet, Roissy, France) showed bilateral tubal dilatation and occlusion. Bilateral salpingoneostomy was performed successfully, with no complication or bleeding. Tubal patency was checked with repeated chromopertubation. The total amount of methylene blue used was 20 mg of dye diluted in 100 ml of

Hysterosalpingokontrastsonographie zur Tubendiagnostik - Kontrolle der Untersuchungsergebnisse durch Laparoskopie - Hysterosalpingo-Contrast Sonography (HyCoSy) for Tubal Diagnostics: Check of the Examination Results by Means of Laparoscopy -

Objective: We studied the agreement between contrast hysterosalpingosonography and laparoscopic chromopertubation for assessing tubal patency. Methods: Contrast hysterosalpingosonography was performed in the initial evaluation of 402 patients with a total of 752 tubes. 124 patients (with a total of 242 tubes) subsequently underwent laparoscopy with chromopertubation. Results: Contrast hysterosalpingosonography indicated tubal patency in 487 (65%) of tubes. 78 of these tubes were pertubated at laparoscopy and 87% were patent. Hysterosalpingosonography indicated occlusion in 265 tubes (35%). 164 of these tubes were pertubated and the diagnosis of occlusion was confirmed in 90 (55%). False negative hysterosalpingosonography findings were more common in tubes with proximal occlusion. Hysterosalpingosonography findings indicating proximal occlusion were confirmed in 23% of tubes, as opposed to 88% for distal occlusion. Conclusion: Contrast hysterosalpingosonography can reliably detect tubal patency and distal tubal occlusion. Hysterosalpingosonography findings suggesting proximal occlusion should be evaluated with chromopertubation.

Stellenwert der Hystero-Salpingo-Kontrast-Sonographie (HyCoSy) zur Abklärung der Tubenfunktion - Contrast Hysterosalpingosonography for Evaluating Tubal Function in Women with Infertility -

Zur Abklärung des tubaren Faktors in der Sterilitätsdiagnostik hat sich neben der Hysterosalpingographie (HSG) und der Chromolaparoskopie (CLS) in den letzten 15 Jahren zunehmend die Hysterosalpingo-Kontrast-Sonographie etabliert. Diese kontrastmittelgestützte ultrasonographische Darstellung der Eileiter ist ein wenig invasives, ambulant durchführbares Verfahren zur Abklärung der Tubendurchgängigkeit. Diese Methode ist hinsichtlich diagnostischer Sicherheit mit der HSG vergleichbar. Daher ist die HyCoSy durchaus als Basisuntersuchung im Rahmen der Sterilitätsdiagnostik geeignet. Zweifelhafte Befunde sollten jedoch nach wie vor durch eine CLS („Goldstandard“) weiter abgeklärt werden.

Screening Sonohysterography in Infertility

This prospective comparative study was carried out to assess the value of sonohysterography (SHG) in evaluating both the endometrial cavity and tubal patency in infertile patients and to compare its results with hysterosalpingography (HSG), diagnostic hysteroscopy and laparoscopic chromopertubation. It comprised 84 infertile women who were examined using SHG the day before combined diagnostic laparoscopy and hysteroscopy. Eighty-three patients had had HSG within 6 months. As regards the appearance of the endometrial cavity, the results of SHG agreed with hysteroscopy in 72.2% (k = 0.31) while HSG agreed with hysteroscopy in 75.6% (k = 0.39) of cases. The appearance of the right and left tubes using SHG agreed with laparoscopy in 72.4% (k = 0.16) and 60.5% (k = 0.13), respectively, while HSG agreed with laparoscopy in 94% (k = 0.52) and 90.4% (k = 0.51), respectively. However, when the appearance of fluid in DP was considered as an indirect indicator of patency of at least one tube at SHG, the agreement with laparoscopy rised to 88.1% (k = 0.24) and 85.7% (k = 0.18) for both tubes respectively. In conclusion, SHG is similar to HSG as regards the appearance of the endometrial cavity but it is inferior to it for evaluating tubal factor. The implication of SHG in the infertility work-up as a simple and fast procedure can minimize costs and abuses of sophisticated techniques particularly in the developing countries with limited resources.

A randomized study comparing air to Echovist(R) as a contrast medium in the assessment of tubal patency in infertile women using transvaginal salpingosonography

This study was undertaken to compare two different contrast media (air and Echovist) in the assessment of tubal patency using transvaginal salpingosonography (TSSG) in 32 infertile women referred to an infertility outpatient clinic. Altogether, 59 Fallopian tubes were examined with TSSG. Laparoscopic chromopertubation was used as a reference method. In group A (air), concordance was 90%, Cohen's kappa coefficient 0.71 [95% confidence interval (CI): 0.64-0.77], sensitivity 63%, specificity 100%, negative predictive value 88% and positive predictive value 100%. In group B (Echovist), the corresponding parameters were as follows: 93%, 0.71 (CI: 0.67-0.76), 60, 100, 93 and 100% respectively. No statistically significant differences were found between these two contrast media. Either one can reliably be used for assessing tubal patency with TSSG in infertile women as a primary phase examination modality.

Assessment of tubal patency with transvaginal salpingosonography after treatment for tubal pregnancy.

Tubal patency was studied in 32 patients who had previously undergone a laparoscopic or laparotomy procedure (salpingostomy, salpingectomy or tubal resection), or who had received a local injection of hypertonic glucose because of tubal pregnancy. Transvaginal salpingosonography (TSSG) was subsequently performed in the follicular phase of the menstrual cycle, and laparoscopic chromopertubation was carried out as a comparative method after TSSG. Of 32 patients (47 Fallopian tubes examined), the affected tube was observed to be patent by TSSG in 68%. The contralateral tube was patent in 93%. Nine patients became pregnant and were thus not subsequently assessed with laparoscopy. Two of these pregnancies ended in a miscarriage and one in a recurrent tubal pregnancy. A concordance of 86% for Fallopian tubes was achieved between the TSSG and laparoscopic chromopertubation methods. When checking the Fallopian tubes separately, the concordance for the results in the affected tubes was 67%, and 100% for the contralateral tube. Therefore TSSG appears to be a practical method for the primary examination of tubal patency in patients treated previously for tubal pregnancy. Guidelines for the treatment of infertility after tubal pregnancy can also be set out according to TSSG findings.

Transvaginal salpingosonography for the assessment of tubal patency in infertile women: methodological and clinical experiences

To evaluate the advantages and accuracy of transvaginal salpingosonography in the assessment of tubal patency with regards to laparoscopic chromopertubation. Infertility policlinic of the hospital. Thirty-one women suffering from infertility were examined with transvaginal salpingosonography using air and saline as a contrast medium. The results were compared with those obtained with laparoscopic chromopertubation. Altogether 61 fallopian tubes were examined with both transvaginal salpingosonography and laparoscopic chromopertubation. Concordance was 85%. Of the tubes investigated by transvaginal salpingosonography, 45 were found to be patent and 16 were found to be occluded. In chromopertubation, 50 of 61 tubes were patent and 11 were occluded. Bilateral tubal patency was found by transvaginal salpingosonography in 17 cases and by laparoscopy in 22 cases. Unilateral tubal patency was found in 11 and 6 cases, respectively. Bilateral occlusion was found in three cases using either technique. Transvaginal salpingosonography with the combination of air and saline is a low-cost, reliable, safe, and comfortable examination method. It can be used for the primary investigation of infertility on an outpatient basis.

Colour Doppler hysterosalpingosonography: a simple and potentially useful method to evaluate Fallopian tubal patency

The diagnostic efficacy of colour Doppler hysterosalpingosonography to evaluate Fallopian tubal patency was studied in 17 women. Of the 17 women, 12 were infertile and the remaining five were fertile and requested elective tubal ligation. Colour Doppler sonography was performed using the transabdominal approach 1-4 weeks after diagnostic laparoscopy during infertility work-up in the former, and 1-2 weeks after bilateral isthmic tubal ligation in the latter group. Sterile saline was used as the contrast agent. Laparoscopic chromopertubation was considered as the gold standard. The sensitivity and specificity of colour Doppler sonography were found to be 93 and 83%, respectively. A kappa value of 0.73 reflected good clinical agreement between the two techniques. Colour Doppler hysterosalpingosonography is concluded to be a relatively accurate and simple procedure to test tubal patency. The other advantages include absence of radiation and avoidance of potential allergic reactions to iodinated contrast agents employed for hysterosalpingography. However, the inability to delineate the inner architecture of the genital canal and to determine the exact location of tubal obstruction, when present, remain the disadvantages of this technique.

Fallopian tube patency using color Doppler

OBJECTIVE: To evaluate a new test for tubal patency using color Doppler ultrasonography in infertile women. METHOD: Between October 1991 and March 1992 results of our new technique were compared with those of hysterosalpingography (HSG) and laparoscopy in 27 cases. The new technique of evaluating tubal patency using color Doppler has been described in detail. RESULT: There was 92.59% agreement, i.e. patency or occlusion of the fallopian tubes when the results of our test were compared with those of hysterosalpingography and laparoscopic chromopertubation. The HSG and laparoscopy findings were in 100% agreement. CONCLUSION: Color Doppler ultrasonography is now a very important investigation in the assessment of fallopian tube patency and compares favorably with the existing ‘gold standards’ namely HSG and laparoscopic chromopertubation.

Histology of proximal tubal occlusion

From 1979 to 1985, 18 patients who were found to have proximal tubal obstruction by hysterosalpingography and laparoscopic chromopertubation underwent resection of the obstructed tubal segment and reimplantation or microanastomosis. Resected tubal segments were studied histologically, and in 11 of the 18 cases no tubal occlusion could be demonstrated. A variety of histologic abnormalities were noted, however, including six cases in which the tubal lumen contained an amorphous material of unknown etiology, often appearing to form a cast of the tube. Such "plugs," which the authors believe to be previously unreported, have no clearly established clinical significance at present. However, if they cause tubal occlusion, this would explain several previously published findings, and would also have implications for therapy.