Trans vaginal endoscopy (a.k.a Fertiloscopy): an Australian perspective. (#C5)
Trans vaginal endoscopy is a simple way to explore the pelvis. A member of the NOTES family (natural orifice trans luminal endoscopic surgery), it naturally belongs to the gynaecologist. For historical reasons, TVE seems restricted to certain countries (Belgium, France, Singapore, Indonesia, etc…) and has not really been embraced in Australia. Pioneering works in Victoria and South Australia in the early 2000’s have not been followed through.
The technique is a development of a forgotten surgical procedure used in the 1960s called culdoscopy. In the 90’s, Belgian authors (1) reported on the development of a standardised procedure of ʺtransvaginal hydro laparoscopyʺ . From that point on, there have been many studies into the transvaginal technique.
Watrelot developed a disposable instrument that makes a more comprehensive procedure possible. He included in the device a conventional hysteroscope, so that the total procedure includes not only the TVE, but also hysteroscopy, and tubal patency check. The technique has also been reported as fertiloscopy. The tip of the introducer is in plastic and is a bit smoother than the usual needle, reducing the risk of bowel trauma. Studies comparing the results obtained with laparoscopy and dye test, and fertiloscopy have shown a high degree of concordance between both routes in the identification of adhesions and endometriosis. (2)
The benefit of the fertiloscopy is the minimal access (no scar, reduced pain, no risk of vascular injury with the introduction, possibility of performing the procedure under local anesthesia and mild sedation as an outpatient case, faster recovery).
The disadvantages are the impossibility to treat complex cases of adhesiolysis and excision of endometriosis in the same time.
Most series report a 5 to 20 % rate of conversion to laparoscopy, if the procedure is judged unsafe or impossible (typically in case of fixed retroverted uterus). Complications include: sepsis, bowel or rectal perforation (less than 1%, and treated conservatively with antibiotics in most cases, as sub peritoneal).
The recent development in bipolar energies (Versapoint generator and disposable electrodes) makes ovarian drilling possible via the fertiloscope. (3)
This presentation will demonstrate the technique (introduction of the trocar, exploration of the pelvis, dye test). We will report about 5 consecutive cases of fertiloscopies performed in Wollongong, including (to the best of our knowledge) the first ever TV ovarian drilling performed in Australia. This is a modest but significant breakthrough in the field of minimally invasive gynaecology in Australia.