Trans-abdominal ultrasound guided transvaginal hydrolaparoscopy is associated with reduced complication rate

Abstract

Objective: To evaluate the feasibility and value of abdominal ultrasound guided access for transvaginal hydrolaparoscopy (THL).

Study design: One hundred and ninety-three infertile women were retrospectively included. A total of 31 subjects were included in the study group, and 162 cases performed prior to the introduction of transabdominal ultrasound guidance constituted a comparison group. The indications for THL were: inconclusive hysterosalpingogram findings and ovarian drilling for clomiphene-resistant polycystic ovarian disease. The total of complications arising from trocar needle insertions are compared between the study (ultrasound guidance) and comparison (without ultrasound guidance) groups.

Results: In the study group, two cases were transferred to standard laparoscopy without vaginal needle insertion because of no obvious fluid in the cul-de-sac. One of these cases was confirmed to have severe adhesions and the other had no pathology in the pelvic cavity. One further case was transferred due to severe adhesions found by THL. Twenty-nine patients had successful vaginal access including seven cases with a retroverted uterus (24.1%), as against only one case with retroverted uterus in the comparison group (0.6%). The difference was statistically significant (P<0.05). There were three cases of intestinal perforation and one case of uterine injury in the comparison group, but no case of complication in the study group. Fifteen cases were fully conducted by two novel medical doctors monitored by a senior doctor.

Conclusions: Trans-abdominal ultrasound guided vaginal access increases the safety of THL, especially in patients with a retroverted uterus, by seeking out a better puncture spot, and making training more intuitive and safe.