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Laparoscopic and Robotic-Assisted Myomectomy
Published in Botros R.M.B. Rizk, Yakoub Khalaf, Mostafa A. Borahay, Fibroids and Reproduction, 2020
Harold Wu, Anja Frost, Mostafa A. Borahay
The patient is positioned in low dorsal lithotomy position in booted support stirrups after adequate general anesthesia has been administered. To allow for adequate surgeon space at the bedside and to avoid hyperabduction of the arms, both patient arms are usually secured and tucked directly at the patient's sides with adequate padding to protect the fingers and pressure points at the wrist and elbow. Following a bimanual examination, the vagina and abdomen are both surgically prepared. A Foley catheter is then inserted, followed by a uterine manipulator (with the capability for chromopertubation if desired).
Initial investigation of the infertile couple
Published in David K. Gardner, Ariel Weissman, Colin M. Howles, Zeev Shoham, Textbook of Assisted Reproductive Techniques, 2017
Isabelle Roux, Ruth Ronn, Peter T.K. Chan, Togas Tulandi, Hananel E.G. Holzer
Laparoscopy with chromopertubation has long been considered as the “gold standard” for evaluating tubal patency. Its advantages include the feasibility to diagnose and treat conditions that decrease fertility, including endometriosis or periadnexal adhesions. However, it is an invasive procedure that requires general anesthesia. The risk of major complications is low (<1%) (68). Laparoscopy is indicated when there is evidence or strong suspicion of endometriosis, pelvic/adnexal adhesions, or significant tubal disease requiring treatment. In the era of ART, today laparoscopy is rarely performed in the workup of infertility.
The Infertility Workup
Published in Steven R. Bayer, Michael M. Alper, Alan S. Penzias, The Boston IVF Handbook of Infertility, 2017
Hysteroscopy and laparoscopy are the gold standard diagnostic procedures performed after an abnormal screening or imaging test. These procedures allow the physician to correct underlying uterine and pelvic pathologies as well as visualize congenital and acquired anatomic abnormalities. Factors that contribute to infertility include endometriosis, peritoneal adhesions, and congenital tubal and uterine malformations. All of these disease processes can contribute to anatomic tubal distortions and even complete obstruction. When tubal patency is unclearly documented after an HSG or SIS procedure, laparoscopy with chromopertubation can discern fallopian tube patency from proximal and distal occlusion. Hysteroscopy with polypectomy, myomectomy, metroplasty, and resection of intrauterine adhesions can quickly and easily restore the anatomy back to normal and improve implantation, pregnancy, and live birth rates [44].
Cornual uterine diverticulum following a failed pregnancy
Published in Gynecological Endocrinology, 2018
Sara Babcock Gilbert, Julia I Reading, Miriam D Post, Ruben Alvero, Zain A Al-Safi
The patient then underwent hysteroscopy and laparoscopy for evaluation of the left uterine cornual structure. On hysteroscopy, multiple small anterior endometrial polyps were identified and removed. No obvious outpouching of the uterus was noted. On laparoscopy, however, a 2 × 3 cm left cornual uterine diverticulum was noted. The left fallopian tube was surgically absent. Normal ovary and fallopian tube were seen on the right. Chromopertubation was performed using dilute methylene blue, which showed filling of the diverticulum, and spill from the right fallopian tube. The uterine diverticulum was then removed after injection of diluted vasopressin using electrocautery. The entirety of the diverticulum, including inner sacculation, was removed until only healthy myometrial tissue remained. The endometrial cavity was entered during this procedure and was closed in a three-layer closure.
Office hysteroscopic-guided selective tubal chromopertubation: acceptability, feasibility and diagnostic accuracy of this new diagnostic non-invasive technique in infertile women
Published in Human Fertility, 2018
Gaspare Carta, Patrizia Palermo, Chiara Pasquale, Valeria Conte, Ruggero Pulcinella, Stefano Necozione, Vincenza Cofini, Felice Patacchiola
Chromopertubation is performed by tubal cannulation under hysteroscopic guidance and subsequent injection of methylene blue into each proximal segment of the Fallopian tube. This new method is faster, cheaper and more widely available than other standard techniques. In accordance with the results obtained by Török and Major (2012), who compared the accuracy of this technique with standard laparoscopy, hysteroscopic tubal assessment showed an 82.9% accuracy with a positive predictive value of 87.5% and a negative predictive value of 76%. They performed the test at the end of a laparoscopic procedure, with the patient under general anaesthesia (Cicinelli, 2010; Török & Major, 2012). To the best of our knowledge, scanty data have been published in the literature regarding the evaluation of tubal patency with office hysteroscopy. Therefore, the aim of this prospective study is to evaluate accuracy, tolerability and side effects of office hysteroscopy-guided chromopertubations in infertile women.