Chapter 12, Page 5

Limitations of HSG and laparoscopy

The trouble with both HSG and laparoscopy is that they only provide information as to whether or not the tube is open or closed. While a closed tube will never work, they do not provide any information on how well an apparently open tube works. Remember that just because a tube is patent does not necessarily mean that it works!

Fig 3. Laparoscopy shows a large hydrosalpinx on the right side

Another limitation is that they will rarely provide any information as to why the tubes are blocked. Occasionally, however, this can be suspected by other signs (for example, by seeing the tubercles diagnostic of TB in the abdomen during laparoscopy).

Recent innovations in the field

Fluoroscopic guided procedures: Using an image intensifier, and techniques borrowed from coronary angioplasty, radiologists can now insert special catheters under fluoroscopic guidance into each of the tubes. This is called selective salpingography; and allows much better visualization of each tube. It also allows the radiologist to treat cornual blocks that are due to mucus plugs, by tubal cannulation.
Sonosalpingography: Under ultrasound guidance, with Doppler facilities, if available, the gynecologist can inject fluid into the tubes through the cervix and see the flow of the fluid into the tubes and abdomen on the ultrasound screen. This is a simple bedside test that a gynecologist can do to judge if the tubes are normal and can be reassuring if positive.
Tuboscopy: At the time of laparoscopy, the doctor can insert a fine telescope into the fallopian tube through its fimbrial end to inspect the inner lining of the tube to judge whether or not it is healthy.

Falloposcopy is a recent advance, the pioneered by Dr Kerin of USA. In this method, a very fine flexible fiber optic tube is guided through the cervix and uterus into each fallopian tube, thus allowing the doctor to actually visualize the inner lining of the entire length of the fallopian tube - something that was never possible so far. This can provide useful information about the extent of tubal damage - and the possibility for successful repair.

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