Transcervical falloposcopy: preliminary experience.
The new technique of endoluminal tubal exploration was evaluated by performing transcervical falloposcopy instead of chromoperturbation under control of concurrent laparoscopy. In this feasibility study, catheterization was performed with the use of either a transhysteroscopic or a free-hand tubal cannulation technique. A total of 66 patients were investigated for primary or secondary infertility with proximal and/or distal suspected tubal defects on the basis of prior hysterosalpingography; three patients were investigated for unruptured tubal pregnancy; two patients were investigated to localize the tip of the tubal embryo transfer catheter. Transcervical catheterization was successful in 110 of the 130 tubes (84.6%). Successful and informative falloposcopy was achieved in 30% of the 110 cannulated tubes. The transcervical free-hand cannulation technique was as effective as the transhysteroscopic approach. Recanalization of at least one tube was achieved in 83% of women with proximal obstruction. Tubal cannulation by the tubal embryo transfer catheter was confirmed by falloposcopy in the two cases where free-hand catheterization was used. This study confirms that it is possible to visualize the tubal lumen and demonstrates that the free-hand cannulation technique is a simple and effective alternative to the transhysteroscopic approach. However, further progress in catheter technology has to be achieved in order to perform regularly successful transcervical falloposcopy in damaged tubes.