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Falloposcopic tuboplasty: an easy, quick, and safe technique
Fertility and Sterility ( IF 6.6 ) Pub Date : 2021-09-15 , DOI: 10.1016/j.fertnstert.2021.08.019
Hidehiko Matsubayashi 1 , Yukiko Takaya 2 , Takumi Takeuchi 3 , Masakazu Doshida 3 , Yasuhiro Ohara 3 , Tomomoto Ishikawa 1
Affiliation  

Objective

To describe our simplified technique for falloposcopic tuboplasty (FT) and demonstrate its principle and results.

Design

A step-by-step description of the technique and demonstration of its principle using a clay model.

Setting

Private infertility clinics in Osaka and Tokyo operated by 10 physicians.

Patient(s)

A total of 431 infertile women with a diagnosis of unilateral or bilateral proximal tubal occlusion (6 cm from the uterotubal ostia), between October 2013 and February 2019 were included. These patients underwent routine work-ups for infertility, including a semen analysis, hysterosalpingography, antimüllerian hormone, basal luteinizing hormone/follicle-stimulating hormone and prolactin concentrations during menstruation, postcoital test in the periovulatory period, and estradiol and progesterone concentrations in the middle of the luteal phase. Physicians performed hysterosalpingography to evaluate tubal patency and uterine shape. Saline infusion sonography was not conducted because it does not accurately identify regions of tubal occlusion and/or stenosis.

Intervention(s)

The principle of our simplified technique for FT is that a hole is located at the side of the FT catheter tip. Therefore, the balloon and fiberscope move away from the catheter line (Fig. 1). The uterotubal ostium is located at the tip-end of the triangle of the uterine cavity. When a balloon is inserted while visualizing the uterotubal ostium at the nearest position to the ostium, the balloon hits the uterine wall. When a balloon is inserted 5–10 mm from the uterotubal ostium without visualization, the balloon may be easily placed in the ostium through its convex angle, allowing it to slide into the uterine wall (Figs. 2 and 3). Step 1: Confirm anteflexion or retroflexion of the uterus by ultrasound. Step 2: Confirm the direction of the uterotubal ostia by hysteroscopy. Step 3: Adjust the angle of the FT catheter according to steps 1 and 2, insert the catheter into the end of the uterus, pull it back 5–10 mm (without visualizing the uterotubal ostia), and then fix it to the forceps. Catheter placement away from the tubal ostium is confirmed by the residual length of the moving part of the catheter. An attending instructor should ask the operator about the feeling of rigidity when the catheter does not advance and then suggest whether to proceed or stop. In the latter case, the catheter is not moved, saline is infused for 1 minute for lubrication, the balloon is pulled back using the fiberscope to remove the bunching of the balloon, and balloon pressure is changed as follows: 6→8→6→10→6 mmHg. Our institutional review board stated that approval was not required because the video describes the technique of our routine procedure.

Main Outcome Measure(s)

A description of the FT technique using a clay model and a demonstration of its application in our clinic.

Result(s)

The average operative time was 15.4 minutes, and the clinical pregnancy rate was 24.4% (natural conception and intrauterine insemination without in vitro fertilization). No significant differences were observed in the operative time or pregnancy rate among physicians. Approximately 17 FT procedures may be performed using one fiberscope.

Conclusion(s)

Our simplified technique, which was described and demonstrated in this video article, is a feasible and practical approach for performing FT. It provides excellent cost performance by saving fiberscopes. The most important point is “Introduce the balloon and fiberscope 5–10 mm away from the uterotubal ostia without visualizing it.” To facilitate learning this technique, we recommend watching the video and then practicing FT without searching for the uterotubal ostia. Physicians master FT without any assistance by an attending instructor in ≤3 attempts.



中文翻译:

输卵管镜下输卵管成形术:一种简单、快速且安全的技术

客观的

描述我们的输卵管镜输卵管成形术 (FT) 的简化技术并展示其原理和结果。

设计

使用粘土模型逐步说明该技术并演示其原理。

环境

大阪和东京的私人不孕不育诊所由 10 名医生经营。

耐心)

共纳入 2013 年 10 月至 2019 年 2 月期间诊断为单侧或双侧近端输卵管闭塞(距子宫输卵管口 6 厘米)的 431 名不孕妇女。这些患者接受了不孕症的常规检查,包括精液分析、子宫输卵管造影、抗苗勒管激素、月经期间的基础促黄体生成素/促卵泡激素和催乳素浓度、围排卵期的性交后测试以及中期的雌二醇和孕酮浓度。黄体期。医生进行了子宫输卵管造影术以评估输卵管通畅情况和子宫形状。没有进行盐水灌注超声检查,因为它不能准确识别输卵管闭塞和/或狭窄的区域。

干预措施

我们的 FT 简化技术的原理是在 FT 导管尖端的一侧有一个孔。因此,球囊和纤维镜会远离导管线(图 1)。子宫输卵管口位于子宫腔三角的顶端。当在最靠近口的位置观察子宫输卵管口时插入气球时,气球会撞击子宫壁。当球囊从子宫输卵管口插入 5-10 毫米而未观察到时,球囊可以很容易地通过其凸角放置在口中,使其滑入子宫壁(图 2 和图 3)。步骤1:通过超声确认子宫前屈或后屈。第二步:通过宫腔镜确认输卵管口的方向。第三步:根据第一步和第二步调整FT导管的角度,将导管插入子宫末端,将其拉回 5-10 毫米(不要看到子宫输卵管口),然后将其固定在镊子上。导管放置在远离输卵管口的位置由导管移动部分的剩余长度确认。指导教师应询问操作者导管未推进时僵硬的感觉,然后建议是继续还是停止。后一种情况,导管不动,注入生理盐水1分钟润滑,用纤维镜将球囊拉回,去除球囊的团块,球囊压力变化如下:6→8→6→ 10→6 毫米汞柱。我们的机构审查委员会表示不需要批准,因为视频描述了我们常规程序的技术。将其拉回 5-10 毫米(不可视化子宫输卵管口),然后将其固定在镊子上。导管放置在远离输卵管口的位置由导管移动部分的剩余长度确认。指导教师应询问操作者导管未推进时僵硬的感觉,然后建议是继续还是停止。后一种情况,导管不动,注入生理盐水1分钟润滑,用纤维镜将球囊拉回,去除球囊的团块,球囊压力变化如下:6→8→6→ 10→6 毫米汞柱。我们的机构审查委员会表示不需要批准,因为视频描述了我们常规程序的技术。将其拉回 5-10 毫米(不可视化子宫输卵管口),然后将其固定在镊子上。导管放置在远离输卵管口的位置由导管移动部分的剩余长度确认。指导教师应询问操作者导管未推进时僵硬的感觉,然后建议是继续还是停止。后一种情况,导管不动,注入生理盐水1分钟润滑,用纤维镜将球囊拉回,去除球囊的团块,球囊压力变化如下:6→8→6→ 10→6 毫米汞柱。我们的机构审查委员会表示不需要批准,因为视频描述了我们常规程序的技术。导管放置在远离输卵管口的位置由导管移动部分的剩余长度确认。指导教师应询问操作者导管未推进时僵硬的感觉,然后建议是继续还是停止。后一种情况,导管不动,注入生理盐水1分钟润滑,用纤维镜将球囊拉回,去除球囊的团块,球囊压力变化如下:6→8→6→ 10→6 毫米汞柱。我们的机构审查委员会表示不需要批准,因为视频描述了我们常规程序的技术。导管放置在远离输卵管口的位置由导管移动部分的剩余长度确认。指导教师应询问操作者导管未推进时僵硬的感觉,然后建议是继续还是停止。后一种情况,导管不动,注入生理盐水1分钟润滑,用纤维镜将球囊拉回,去除球囊的团块,球囊压力变化如下:6→8→6→ 10→6 毫米汞柱。我们的机构审查委员会表示不需要批准,因为视频描述了我们常规程序的技术。指导教师应询问操作者导管未推进时僵硬的感觉,然后建议是继续还是停止。后一种情况,导管不动,注入生理盐水1分钟润滑,用纤维镜将球囊拉回,去除球囊的团块,球囊压力变化如下:6→8→6→ 10→6 毫米汞柱。我们的机构审查委员会表示不需要批准,因为视频描述了我们常规程序的技术。指导教师应询问操作者导管未推进时僵硬的感觉,然后建议是继续还是停止。后一种情况,导管不动,注入生理盐水1分钟润滑,用纤维镜将球囊拉回,去除球囊的团块,球囊压力变化如下:6→8→6→ 10→6 毫米汞柱。我们的机构审查委员会表示不需要批准,因为视频描述了我们常规程序的技术。

主要观察指标)

使用粘土模型描述 FT 技术并演示其在我们的临床中的应用。

结果)

平均手术时间15.4分钟,临床妊娠率为24.4%(自然受孕和宫腔内人工受精,无体外受精)。医生之间在手术时间或妊娠率方面没有观察到显着差异。使用一台纤维镜可以执行大约 17 次 FT 程序。

结论

我们在本视频文章中描述和演示的简化技术是执行 FT 的一种可行且实用的方法。它通过节省纤维镜而提供卓越的性价比。最重要的一点是“将球囊和纤维镜引入距子宫输卵管口 5-10 毫米处,但不要对其进行可视化。” 为便于学习此技术,我们建议您观看视频,然后在不寻找输卵管口的情况下练习 FT。医师在 ≤ 3 次尝试中掌握 FT,无需主讲教师的任何帮助。

更新日期:2021-11-24
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