Fertiloscopy – An Overview

The fertiloscope is a type of laparoscope, modified to make it suitable for trans-vaginal application, which is used in the diagnosis and treatment of female infertility.

This relatively new surgical technique is used for the early diagnosis and immediate treatment of a number of disorders of the female reproductive organs and can be considered one of the first standard NOTES (Natural Orifice Transluminal Endoscopic Surgery) procedures. A large body of published research is available on the application of this surgical technique using the device.

Fertiloscopy provides a minimally invasive, potentially office-based procedure for the clear diagnosis of two major causes of infertility in a manner enabling rational choices at the start of infertility treatment.
The fertiloscopy procedure

Fertiloscopy combines Lap and Dye, Salpingoscopy and Microsalpingoscopy (MSC) and Hysteroscopy in two instruments presented as a single kit. It uses for the entire procedure a single narrow scope (Hamou 2, from Storz or equivalent) that has a 30 degree chamfer which enables a panoramic view by rotating the scope, and a zero to 100X magnification controlled by a rotating knurled knob:

  1. The basis of the procedure is a laparoscopy performed under local anaesthesia via the vagina and the pouch of Douglas rather than via the abdominal wall and the peritoneal cavity. The benefit of this route of entry for the patients is that the procedure is minimally invasive, with no scar. Because it is carried out under local anaesthesia it is well accepted by patients who can go home in two hours.
    The doctor can carry out the procedure with a single hand, which can lead to savings in time and cost. Fertiloscopy is deemed to be safe because of the use of saline solution instead of Carbon dioxide, because of no requirement to use the head down position, and because the procedure is carried out entirely below the peritoneum, eliminating the risk of peritonitis if the bowel is inadvertently punctured. In addition the procedure is carried out without disturbing the position of the internal organs, thus allowing the detection of abnormalities normally not seen during conventional laparoscopy.
    Published data show that injury to major blood vessels is practically impossible and there are very few other minor complications when performed in the right manner. This one risk has been reported: that if a thorough physical examination of the pelvic space between vagina and rectum is not carried out, and if in fact the patient has severe endometriosis causing a fixed retroverted uterus, then there is a risk of rectal puncture. Proper training in the technique makes sure that patients with severe endometriosis and fixed retroverted uterus are excluded, and this minimises this risk. The paper by Nohuz, Pouly, Bolandard, Rabishong, Jardon, Cotte, Rivoire and Mage (2006) confirms this .
  2. During the procedure, dye is introduced via the uterus into the fallopian tube and observed appearing (or not) in the pouch of Douglas. MSC is then performed using the same scope as for the laparoscopic investigation in order to identify and assess damage to the mucosa. The natural position of the tubes allows an easy approach (unlike the Lap and Dye procedure)
  3. At the end of the procedure a full hysteroscopy is performed