Keltz, M., Brown, E. C., Frishman, G. N., & Sauerbrun-Cutler, M. T. (2022). Fluoroscopically-Guided Hysteroscopic Tubal Cannulation: A Procedure for Proximal Tubal Obstruction. JSLS : Journal of the Society of Laparoendoscopic Surgeons. https://doi.org/10.4293/JSLS.2022.00047
Keltz M, Brown EC, Frishman GN, Sauerbrun-Cutler MT. Fluoroscopically-Guided Hysteroscopic Tubal Cannulation: A Procedure for Proximal Tubal Obstruction. JSLS : Journal of the Society of Laparoendoscopic Surgeons. 2022. doi:10.4293/JSLS.2022.00047
Keltz, Martin, et al. "Fluoroscopically-Guided Hysteroscopic Tubal Cannulation: A Procedure for Proximal Tubal Obstruction." JSLS : Journal of the Society of Laparoendoscopic Surgeons, 2022.
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RRM Academy Synopsis
Fluoroscopy-guided cannulation opened 34 of 38 blocked fallopian tubes
Fluoroscopy-guided tubal cannulation opened 34 of 38 blocked fallopian tubes in a retrospective series of 32 women. One surgeon treated them all. Each woman had a blockage near the uterus and had failed a first try in the radiology suite. Ten of 29 women trying without IVF had an intrauterine pregnancy.
Key Findings
Twenty-nine of 32 women (90.6%) had at least one tube successfully cannulated. Patency was achieved in 34 of 38 (89.5%) proximally obstructed tubes.
With bilateral obstruction, 6 of 6 women (100%) achieved at least unilateral patency. With unilateral obstruction, patency was achieved in 23 of 26 (88.5%).
One tube perforation occurred among 38 tubes (2.6%), with no symptoms. The paper reports no postoperative complications.
Of 29 women who tried to conceive without IVF, 10 (34.5%) had an intrauterine pregnancy, and 3 of those 10 ended in miscarriage. Ongoing clinical pregnancy was 7 of 29 (24.1%).
Among women with an intrauterine pregnancy without IVF, the mean time was 64.9 days after the procedure. One ectopic pregnancy occurred, and there were no multiple pregnancies.
Interpretation
This retrospective case series followed one surgeon's results in 32 women. The authors consider it likely that the procedure contributed to some pregnancies. Twelve women had a positive pregnancy test after ovulation induction with insemination or timed intercourse, and three women went straight to IVF. Women aged 18 to 44 with a blockage near the uterus were included, and blockage in the middle or far end of the tube was excluded. The findings support larger studies of this tubal-sparing approach.
RRM Context
Restorative reproductive medicine looks for the cause of infertility and treats it. A blocked tube near the uterus is a located, physical cause, and tubal cannulation acts on that tube. IVF bypasses the tubes and leaves the blockage in place. The authors excluded couples with another recognized cause, such as male factor, so the tubes sit inside a couple-level evaluation.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objectives
To evaluate the cannulation success rate, cumulative pregnancy, and time to intrauterine pregnancy rate following fluoroscopically-guided hysteroscopic tubal cannulation (FHTC) for infertile subjects with proximal tubal obstruction.
Methods
This retrospective study evaluated subjects with unilateral or bilateral proximal tubal obstruction on hysterosalpingography, who failed concomitant selective salpingography and subsequently underwent FHTC at the time of a hysteroscopy performed for findings seen on sonohysterography. FHTC employed a Novy Catheter (CooperSurgical, Inc, Trumbull, CT.) with or without the 3 French inner catheter and guidewire, to cannulate the occluded fallopian tube(s), followed by the injection of HypaqueTM (Amersham Health, Inc, Princeton, NJ.) contrast under C-arm imaging. Technical success rates, complications, post-procedure pregnancies, and average time from surgery to pregnancy were evaluated.
Results
Thirty-two women between January 1, 2017 and December 31, 2019 met the entry criteria and underwent FHTC. Of those women with bilateral obstruction, 6/6 (100%) of subjects achieved at least unilateral patency, while patency was achieved in 23/26 (88.5%) subjects with unilateral obstruction. Twenty-nine of 32 (90.6%) subjects had at least one tube successfully cannulated with 34/38 (89.5%) of proximally obstructed tubes opened. Asymptomatic tubal perforation occurred in 1/38 tubes (2.6%). Ten subjects (34.5%) achieved intrauterine pregnancies without in vitro fertilization in an average of 64.9 days from the procedure. There were no multiple pregnancies and one ectopic pregnancy.
Conclusions
FHTC is a safe, effective, incision free procedure that results in 90% of tubes successfully cannulated, and an observed short time to intrauterine pregnancy.
