Double-optic laparoscopy. Salpingoscopy, ovarian cystoscopy and endo-ovarian surgery with the argon laser

Abstract

Salpingoscopy gives detailed visual information on the mucosal pattern of the tubal ampulla as far as the isthmoampullary junction. With experience it takes 10 minutes to perform salpingoscopy on both sides and with an additional dye test a most complete evaluation of tubal morphology and patency can be obtained during routine diagnostic laparoscopy. Comparative studies proved the technique to be superior to HSG and the laparoscopic inspection of the tubal serosa and of the fimbriae. In some instances, like a tubocornual block, only salpingoscopy can provide additional information. Eventually, with the current techniques of operative laparoscopy salpingoscopic inspection of a phimosis or even a hydrosalpinx can be performed quite easily and these findings help us in the clinical management of patients requiring either microsurgical cuff-salpingostomy (giving a more realistic chance of a spontaneous pregnancy every month) or in vitro fertilization (avoiding laparotomy). Salpingoscopy also guides us in the selection of patients for a GIFT procedure and probably provides a better estimation of the risk of ectopic pregnancy. Ovarian cystoscopy can be applied for accurate diagnosis of non-malignant ovarian cysts at the time of laparoscopy. The wall of the cyst is inspected in detail and selective biopsies are obtained. Unnecessary surgery for non-neoplastic tumours can be avoided and endometrial and cystic tumours can be treated in situ using an argon laser with minimal surgical damage to the ovarian capsule. This laser technique is under further investigation to evaluate its place in the diagnosis and conservative surgical treatment of benign ovarian cysts occurring during reproductive life.