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Ultrasonographically guided transvaginal hydrolaparoscopy

This is a new method of direct examination of the female reproductive organs, developed in our department. The former THL (transvaginal hydrolaparoscopy) is improved by using ultrasound during the whole procedure. It make it nearly absolutely safe.

UTHL is a simple outpatient procedure. Access to the abdominal cavity is through the vaginal wall under the inspection of ultrasound. Single-use instruments (punction needle, dilatator, trocar) are used.

All patients undergo a mandatory standard hysteroscopy as a preliminary to UTHL. This allows the introduction of saline into the pouch of Douglas through the fallopian tubes.

Special UTHL instruments are inserted into the abdominal cavity under ultrasonographical control. Live ultrasound and hydrolaparoscopic images can be viewed separately on two screens or both images can be superimposed onto one screen. Our set up makes it possible to carry out a detailed visual inspection of the posterior uterine wall, the uterosacral ligaments and the tubo-ovarian complex under saline and on US.  Liquid dye intubation using methylene blue is performed on all patients.

At the end of the procedure, the excess fluid is drained from the abdominal cavity under US control, followed by the removal of all instruments so that the posterior vaginal fornix is left to close spontaneously. Prophylactic antibiotics are prescribed for 3-5 days for all patients. All the UTHL procedures described here are performed on an outpatient basis with a 2-hour post-operation stay.

For operative procedures (adhesiolysis, ovarian drilling, endocoagulation) we have opted for an operating trocar with an inner diameter of 6 mm, instead of a diagnostic trocar. An operation hysteroscope with a 2 mm operational canal is used in this procedure. Endocoagulation is achieved by means of a bipolar endoprobe in a saline solution.

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Advantages of UTHL:

  • outpatient procedure (3-hour stay in the operation department)
  • safe (under ultrasonographic control)
  • short recovery time (2-3 days), from next period IVF can be performed
  • no waiting list (we can perform it just after your period)
  • no umbilical or abdominal scar 

Indications:

  • infertility
  • abdominal pain

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