Transvaginal Hydrolaparoscopy advocated: Evaluates infertility, pelvic pain.

SAN FRANCISCO -- Transvaginal hydrolaparoscopy is a simpler, safer, and cheaper alternative to hysterosalpingography and transabdominal laparoscopy for the evaluation of infertility or gynecologic problems.

That's the assessment of two physicians who used. the technique in two uncontrolled series of 109 U.S. cases and 400 German cases. The investigators reported their experiences at the annual meeting of the American Association of Gynecologic Laparoscopists.

Transvaginal hydrolaparoscopy is a form of culdoscopy performed via a transvaginal puncture with the patient in the dorsal lithotomy position instead of the knee-chest position. It uses saline rather than carbon dioxide as the medium for floating the pelvic organs and visualization, and can be performed in the office with local anesthesia. Previous studies have found transvaginal hydrolaparoscopy to be as accurate as laparoscopy 82%-91% of the time.

Infertile patients who undergo hysterosalpingography generally get treated for 3-10 months before having more definitive laparoscopic intervention, they argued. Doing transvaginal hydrolaparoscopy earlier may direct patients more efficiently to appropriate therapy without delay.

Not everyone, however,, is enamored with transvaginal hydrolaparoscopy "We're describing a procedure that certain people have fallen in love with, but the procedure has to stand on its own legs in terms of value," Dr. Stephen L. Corson said while moderating a session at the meeting.

But several speakers at the meeting expressed their support for the procedure. For example, Dr. Michael L. Moore said he uses transvaginal hydrolaparoscopy, sometimes in combination with hysteroscopy and chromopertubation, instead of hysterosalpingography, to evaluate infertile patients. He also prefers transvaginal hydrolaparoscopy as the first approach to endoscopic diagnosis of gynecologic problems. Dr. Moore has offered selected patients operative transvaginal hydrolaparoscopy using an electrode to vaporize stage I/Il endometriosis or thin, filmy adhesions.

Proper studies have not yet been done to determine whether transvaginal laparoscopy should be used for initial infertility evaluations. Anecdotal reports do not prove that transvaginal hydrolaparoscopy contributes to pregnancy rates or provides information that cannot be had in other ways, cautioned Dr. Corson of Philadelphia.