Transvaginal Endoscopy (TVE) is created to diagnose the cause of infertility. It is meant to avoid the risk of injury that cause by laparoscopy as a gold standar procedure for tuboperitoneal infertility, but still able to evaluate the posterior uterus, pelvic sidewalls, and adnexae. In 1998, the Leuven group (Gordts et al., 1998) described Trans Hydrolaparoscopy for exploration of the pelvic exploration of infertile patients without obvious pelvic pathology. The technique uses the transvaginal route, the patient lies in dorsal decubitus and access to the pouch of Douglas is achieved by a culdocentesis technique using a combined Veress needle-trocar system. abdominal distention is obtained by instillation of saline or preferably lactated Ringer's solution. In this way, the new technique adds the benefits of hydroflotation to the closer, clearer and more detailed view of the Fallopian tubes and ovaries achieved by culdoscopy.

Outpatient setting for diagnostic TVE can be done under local anesthesia. Combined with diagnostic hysteroscopy and chromotubation, it can replace hysterosalpingography (HSG) as the first-line diagnostic test for the infertile woman. Studies have shown high patient tolerability with less pain reported post procedure than with HSG. TVE has been shown to have a high concordance with HSG for tubal patency, but TVE diagnosed more intrauterine abnormalities as well as finding adhesions and endometriosis not visible with HSG. In addition, salpingoscopy may be performed during TVE to assess the tubal lumen. TVE also has a high concordance rate with laparoscopy when a complete evaluation is accomplished during TVE. Complications of TVE are uncommon and minor.

This presentation will elaborate and discuss generally about TVE instrumentation, indication – contraindication and the procedure itself and more about the patient selection, preparation and the challenges that we have to encounter to make this procedure as a daily office routines. There will also some Indonesian data that show the feasibility, performance and complication of TVE.