Salpingoscopy during laparoscopy using a small-caliber hysteroscope introduced through an accessory trocar.

Salpingoscopy is an endoscopic technique that allows the direct visualization of the tubal mucosa. The status of the tubal mucosa is the best prognostic factor when evaluating patients with tubal infertility. Salpingoscopy, performed during laparoscopy, has not reached wide acceptance due the costly, non-user-friendly, dedicated instrumentation needed. In this article, a simplified technique to perform salpingoscopy at the time of laparoscopy is reported, using a standard 2.9-mm diagnostic hysteroscope, with a 3.7-mm single-flow diagnostic sheath, introduced through an accessory port. Salpingoscopy, with this new technique, was performed in 13 patients with tubal infertility. The tubes were successfully cannulated in all patients, for a total of 24 tubes evaluated (2 patients had a single tube). Salpingoneostomy and salpingoovarolysis were completed after salpingoscopy only when the tubal mucosa was normal. In 1 patient with severe tubal damage, salpingectomy of the single remaining tube was performed. Salpingoscopy added a mean of 15 minutes to surgical time. Intrauterine pregnancies were obtained, after salpingoneostomy, fimbrioplasty, or adhesiolysis, in 5 of 12 patients (42%), with a mean follow-up of 9 months. The simplified technique of salpingoscopy, with a diagnostic hysteroscope introduced through an accessory trocar at the time of laparoscopy, adds important information on the reproductive potential of patients with tubal disease.