Atlas of Transvaginal Endoscopy PDF

Preface

Infertility is a complex disorder with significant medical, psychological and economic aspects. Both the prevalence of infertility and the number of patients seeking treatment of this disorder are increasing. With the introduction and the widespread use of assisted reproductive technologies (ART), the role of diagnostic laparoscopy in the evaluation of infertility has become controversial. Laparoscopy is invasive and expensive and is frequently omitted or postponed in the exploration of the infertile couple. The relative invasiveness of the standard endoscopic techniques and the increasing quality of the indirect imaging techniques are favouring this evolution, possibly resulting in a rather liberal referral to ART programs.

Up till now, however, direct visualisation of the different organs has proved to be superior to indirect imaging techniques. The easy vaginal accessibility of the uterus for hysteroscopy and the close contact of the tubo-ovarian organs with the posterior vaginal fornix make a transvaginal endoscopic approach tempting. Indeed culdoscopy was the first technique offering the possibility of direct visualisation of the tubo-ovarian structures. The availability of small diameter endoscopes with high quality images offers today a minimally invasive way of access, enabling the accurate examination by direct visualisation of the reproductive pelvic structures, which was previously impossible. Both hysterosalpingography and diagnostic laparoscopy can be replaced by hysteroscopy and transvaginal hydrolaroscopy (TVL) as an ambulatory ‘one stop fertility exploration'. In addition, TVL has been developed as a surgical tool in cases of ovarian capsule drilling in polycystic ovary syndrome, ovarian endometriosis and tubo-ovarian adhesions.

This atlas will show the reader the possibilities of the transvaginal approach in the exploration and, where possible and when indicated, surgical treatment of the uterus and tubo-ovarian structures.