Transvaginal hydrolaparoscopy.

In 1998, Gordts et al. introduced the concept of transvaginal hydrolaparoscopy (THL) to explore the pelvic cavity through a vaginal incision using a saline solution medium. Several reviews have validated the concept of THL in comparison to the gold standard, i.e. laparosco-py. In a literature review of 187 patients from six studies including one prospective double blind trial, a high concordance was found between THL and laparoscopy ranging from 77.8% to 100%. In a review of 1516 THL, the rate of failure was 5.4% and linked to a retroverted uterus and the presence of adhesions. Another review of 1205 THL, revealed that complete exploration of the pelvis including analysis of both sides with visualization of ovaries and tubes was achieved in 88.3%. In a review of 4232 procedures from 10 studies, bowel injuries occurred in 0.61%. In a multicenter study, the incidence of bowel perforation was 0.65% and decreased to 0.25% after an initial learning experience of 50 THL: 92% of these bowel injuries were managed expectantly without consequences. In addition to diagnostic THL, the relevance of operative THL has been validated mainly for ovarian drilling for polycystic ovary syndrome. Despite the advantages of THL in terms of cost, reliability as compared to laparoscopy in detecting pelvic abnormalities and its superiority in detecting subtle lesions, as well as the feasibility of performing it under local anesthesia thereby contributing to the couple's participation, uptake of THL remains relatively low underlining the need to promote this minimally invasive procedure.