Transvaginal hydrolaparoscopy compared with laparoscopy for the evaluationof infertile women: a prospective comparative blind study

Standard diagnostic laparoscopy is considered the gold standard to investig ate tubo-peritoneal infertility, It requires general anaesthesia and full o perative facilities. Due to the risk of complications, laparoscopy is frequ ently postponed to the final stage of infertility evaluation or even after treatment trials have failed. Transvaginal hydrolaparoscopy (TILL) is based on vaginal access using a needle puncture technique and saline for distent ion. THL can be performed on an outpatient basis under local anaesthesia, H owever, little data exist concerning the accuracy of THL in comparison with laparoscopy. We conducted a prospective comparative blind trial to assess the feasibility and accuracy of THL compared with diagnostic laparoscopy in infertile women. Sixty women were assigned to undergo THL immediately prio r to laparoscopy, Different operators evaluated the findings of the two pro cedures. In order to evaluate the accuracy of THL, findings in terms of tub al pathology, endometriosis and adhesions were analysed. The success rate o f accessing the pouch of Douglas was 90.2%. Complication rate was 1.6%. THL diagnosis was correlated with that of laparoscopy in 92.3% of cases. In ca ses of abnormal findings by THL, there were no normal laparoscopies, Our pi lot study suggests that THL is a safe and reproducible method. Retroverted uterus should be considered as a relative contraindication to THL. When a c omplete evaluation by THL is available, it is a highly accurate technique i n comparison with the laparoscopy.