Falloposcopy (occasionally also falloscopy
) is the inspection of the
fallopian tubes through a micro-
endoscope
An endoscope is an inspection instrument composed of image sensor, optical lens, light source and mechanical device, which is used to look deep into the body by way of openings such as the mouth or anus. A typical endoscope applies several modern t ...
.
The falloposcope is inserted into the tube through its opening in the
uterus
The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The ...
at the proximal tubal opening via the
uterotubal junction
The uterotubal junction is the connection between the endometrial cavity of the uterus and the fallopian tube (uterine tube) at the proximal tubal opening, the beginning of the intramural part of the fallopian tube. Histologically, the endometrial ...
; technically it could also be inserted at the time of abdominal surgery or laparoscopy via the distal fimbriated end.
A distinction is sometimes made between falloposcopy and salpingoscopy (with salpinoscopy being laparoscopic.)
In some contexts the terms are equated.
Indications
Falloposcopy has been primarily used in diagnosis and management of tubal infertility, however, it is generally not considered part of the routine work-up for infertility.
[ Most tubal problems in women with infertility are treated by IVF. There is no established role for falloposcopy for evaluation of other tubal pathology.
]
Instrumentation
The first modern falloposcope that was described was the coaxial system by Kerin in 1970.[ Later the linerar-everting catheter (LEC) system was introduced.][ A coaxial falloposcope is an microendoscope of 0.5 mm diameter that is flexible and contains optical and illuminating fibers; it has a magnifying capacity. The coaxial system needs a hysteroscope for its uterine passage. In contrast, the LEC system consists of an external unfurling ballon catheter with an internal endoscope that is used transcervically without the need for a hysteroscope.][
]
Procedure
The patient needs general anesthesia
General anaesthesia (UK) or general anesthesia (US) is a medically induced loss of consciousness that renders the patient unarousable even with painful stimuli. This effect is achieved by administering either intravenous or inhalational general ...
or conscious sedation
Procedural sedation and analgesia (PSA) is a technique in which a sedating/dissociative medication is given, usually along with an analgesic medication, in order to perform non-surgical procedures on a patient. The overall goal is to induce a decr ...
for the duration of the procedure and is in a lithotomy position
The lithotomy position is a common position for surgical procedures and medical examinations involving the pelvis and lower abdomen, as well as a common position for childbirth in Western nations. The lithotomy position involves the positioning of ...
. For the coaxial system initially a hysteroscope is introduced into the uterus to identify the proximal tubal ostium.
Findings and interventions
The typical method of tubal evaluation, hysterosalpingography
Hysterosalpingography (HSG), also known as uterosalpingography, is a radiologic procedure to investigate the shape of the uterine cavity and the shape and patency of the Fallopian tubes. It is a special x-ray using dye to look at the womb (ute ...
, has shortcomings in terms of false negative and false positive results.[ It has been argued that falloposcopy allows for a more accurate evaluation of the tubal canal.][ Obstructions, adhesions within the tubal canal, and debris can be identified. The procedure allows removal of debris or filmy adhesions from within the fallopian tube, further in selected cases proximal tubal obstruction can be overcome and the tube can be recanalized allowing for pregnancy.][ Proximal tubal occlusion has also been overcome by using hysteroscopy with tubal canalization using a catheter, not a falloposcope.]tubal obstruction
Fallopian tube obstruction, also known as fallopian tube occlusion is a major cause of female infertility. Blocked fallopian tubes are unable to let the ovum and the sperm converge, thus making fertilization impossible. Fallopian tubes are also kn ...
, however, cannot be overcome by falloposcopy and would require tubal surgery or in vitro fertilization
In vitro fertilisation (IVF) is a process of fertilisation where an egg is combined with sperm in vitro ("in glass"). The process involves monitoring and stimulating an individual's ovulatory process, removing an ovum or ova (egg or eggs) f ...
(IVF) to be overcome to achieve a pregnancy.[
]
Complications
Perforation of a fallopian tube appears the only reported complication and is encountered in about 4-5% of inspected tubes.[
]
Limitations
In 2001, Rimbach et al. reported in a large multicenter study involving 367 patients on the limitations of the procedure.[ Thus, the investigators were able to fully examine tubes in only 2 out of 3 cases; perforations occurred in about 4% of cases. Since then, interest in falloposcopy has declined and few studies have been published.
The procedure is not usually used in the United Kingdom.]
References
{{Female genital procedures
Endoscopy
Female genital procedures