OUTPATIENT FALLOPOSCOPY - INTRALUMINAL IMAGING OF THE FALLOPIAN-TUBE BY TRANSUTERINE FIBEROPTIC ENDOSCOPY AS AN OUTPATIENT PROCEDURE

Objective To develop trans-uterine falloposcopy using the linear eversion technique in outpatients, Design A prospective, descriptive study of the introduction and application of this new technique. Setting A tertiary referral University Research Clinic independent of operating theatres and inpatient admission. Subjects Twenty-one infertile women with previous evidence of fallopian tube disease. Main outcome measures Rate of successful tubal cannulation and procedure completion, tubal section visualized, condition of the tubal epithelium, subsequent treatment plan. Results A bilateral examination was attempted in 19/21 patients and completed in 18. Two early falloposcopies with inadequate analgesia were aborted due to pain after only one tube had been examined without an attempt to identify or cannulate the contralateral tubal ostium. In one patient, neither ostium was identified or cannulated. After ostial localization, 37/37 tubes were cannulated. If the ostium was not localized but 'blind' cannulation attempted, 1/3 were cannulated successfully. Epithelium characteristic of the ampulla was seen in 31/38 (82%) tubes, and of the proximal tube only in 3/38 (8%). Successful bilateral assessment noted complete bilateral proximal obstruction in 2/18 patients, non-obstructive bilateral endotubal damage in 7/18, unilateral damage in 3/18 and bilateral healthy tubes in 6/18. Unilateral examination in two patients found minimal evidence of damage in one and severe intra-tubal adhesions in the other. After falloposcopy, 11/21 patients elected for IVF, 9/21 tubal surgery and 1/21 for IVF whilst awaiting surgery. Conclusion Falloposcopy is a technique which can be performed in an outpatient clinic. It is well tolerated, and high rates of luminal cannulation and visualization are possible. Atraumatic access to the tube and visualization of its lumen offer exciting opportunities for diagnosis and treatment of tubal conditions.