Falloposcopy. A microendoscopic transvaginal technique for diagnosing and treating endotubal disease incorporating guide wire cannulation and direct balloon tuboplasty.

Direct visualization of the entire length of the fallopian tube lumen, from the uterotubal ostium to the fimbria, using a transvaginal approach, has been achieved. Small, flexible hysteroscopes with outside diameters (ODs) ranging from 3.3 to 4.5 mm and operating channel diameters of 1.5 to 1.8 mm were used to pass guide wires, over-the-wire catheters and a falloposcope with an OD of 0.5 mm safely along the fallopian tube lumen. Forty-three falloscopy procedures were performed. The normal falloposcopic appearance of the fimbrial, ampullary, isthmic and intramural tubal epithelium was characterized in eight cases. In 35 falloposcopies, endotubal lesions were found and characterized. They included 5 cases of intramural stenosis; 10 of isthmic stenosis; 5 of isthmic obstruction; 2 of salpingitis isthmica nodosa; 10 of nonobstructive endotubal disease from intraluminal adhesions, associated devascularization and epithelial atrophy in the intramural, isthmic and ampullary segments; 2 of hydrosalpinx; and 1 of an intratubal polyp. A technique of guide wire cannulation and balloon tuboplasty under hysteroscopic-falloposcopic-laparoscopic control was developed for attempting to dilate a stenotic tube, open up an obstruction or break down intraluminal adhesions. A combination of 32 guide wire cannulation and direct balloon tuboplasty (DBT) procedures was performed. Guide wire cannulation and DBT were effective in breaking down non-obstructive intraluminal adhesions in 6/10 cases (60%), dilating intramural or isthmic stenoses in 6/15 cases (40%) and negotiating an isthmic stricture secondary to salpingitis isthmica nodosa in 1/2 cases (50%). Those procedures failed to bypass complete fibrotic obstructions in 5/5 cases.(ABSTRACT TRUNCATED AT 250 WORDS)