Effectiveness, safety, and feasibility of laparoscopic guided hysteroscopic tubal cannulation in women with proximal fallopian tube obstruction

ABSTRACT
Objective. Tubal cannulation for proximal fallopian tube obstruction has been performed since the 1800s through many approaches; blindly, fluoroscopically, hysteroscopically, or with combined laparoscopy and hysteroscopy guidance. Among these methods, hysteroscopic tubal cannulation under direct laparoscopic guidance is one of the most frequently performed techniques. The aim of this work is to assess the feasibility, safety, and effectiveness of hysteroscopic tubal cannulation in cases of proximal tubal obstruction.
Patients and Methods. The study population was 50 eligible women with proximal tubal obstruction, diagnosed by means of hysterosalpingogram and/or laparoscopy. Tubal cannulation was performed by combining a diagnostic laparoscope with hysteroscopic guidance of a cannula, namely, a size 3 French double J ureteric catheter, into the ostium of the affected tube(s) and performing a novel dye test or selective chromopertubation.
Results. Success was estimated in terms of success per tube and per patient (where spillage was successfully achieved from at least one obstructed fallopian tube). Regarding the success rate per tube, out of the 65 cannulated fallopian tubes, successful spillage was achieved in 67.7% (44 tubes). The success rate per patient was 70%, with a success rate of 65.7% in women with unilateral proximal tubal obstruction and 80% in those with bilateral obstruction. More than 90% of attempts of tubal cannulation were uncomplicated; only 5 attempts (7.7%) were associated with minor complications. Conclusions. Laparoscopy guided hysteroscopic tubal cannulation seems to be a safe, feasible, and effective procedure for the restoration of tubal patency in women with proximal fallopian tube obstruction.