Falloposcopy
Template:Infobox diagnostic Falloposcopy (occasionally also falloscopy<ref name=schill>Template:Cite journal</ref>) is the inspection of the fallopian tubes through a micro- endoscope.<ref name=wong>Template:Cite journal</ref> The falloposcope is inserted into the tube through its opening in the uterus at the proximal tubal opening via the uterotubal junction; technically it could also be inserted at the time of abdominal surgery or laparoscopy via the distal fimbriated end.
A distinction is sometimes made between falloposcopy and salpingoscopy (with salpinoscopy being laparoscopic.)<ref name="Padubidri2005">Template:Cite book</ref> In some contexts the terms are equated.<ref name="FinkelsteinFinkelstein2005">Template:Cite book</ref>
IndicationsEdit
Falloposcopy has been primarily used in diagnosis and management of tubal infertility, however, it is generally not considered part of the routine work-up for infertility.<ref name=rimbach/> Most tubal problems in women with infertility are treated by IVF. There is no established role for falloposcopy for evaluation of other tubal pathology.Template:Citation needed
InstrumentationEdit
The first modern falloposcope that was described was the coaxial system by Kerin in 1970.<ref name=rimbach/> Later the linerar-everting catheter (LEC) system was introduced.<ref name=wong/> A coaxial falloposcope is an microendoscope of 0.5 mm diameter that is flexible and contains optical and illuminating fibers; it has a magnifying capacity. The coaxial system needs a hysteroscope for its uterine passage. In contrast, the LEC system consists of an external unfurling ballon catheter with an internal endoscope that is used transcervically without the need for a hysteroscope.<ref name=wong/>
ProcedureEdit
The patient needs general anesthesia or conscious sedation for the duration of the procedure and is in a lithotomy position. For the coaxial system initially a hysteroscope is introduced into the uterus to identify the proximal tubal ostium.<ref name=kerin>Template:Cite journal</ref> Once the ostium is identified the falloposcope can be inserted through the operative channel of the hysteroscope and advanced. With the LEC system the balloon catheter is advanced into the uterine horn, and then, under endoscopic vision the endoscope is advanced into the tube as the balloon catheter unfurls. Findings can be projected on a videosystem.Template:Citation needed
Findings and interventionsEdit
The typical method of tubal evaluation, hysterosalpingography, has shortcomings in terms of false negative and false positive results.<ref name=wong/> It has been argued that falloposcopy allows for a more accurate evaluation of the tubal canal.<ref name=wong/> Obstructions, adhesions within the tubal canal, and debris can be identified. The procedure allows removal of debris or filmy adhesions from within the fallopian tube, further in selected cases proximal tubal obstruction can be overcome and the tube can be recanalized allowing for pregnancy.<ref name=schill/> Proximal tubal occlusion has also been overcome by using hysteroscopy with tubal canalization using a catheter, not a falloposcope.<ref>Template:Cite journal</ref> Extensive tubal obstruction, however, cannot be overcome by falloposcopy and would require tubal surgery or in vitro fertilization (IVF) to be overcome to achieve a pregnancy.<ref name=kerin/>
ComplicationsEdit
Perforation of a fallopian tube appears the only reported complication and is encountered in about 4-5% of inspected tubes.<ref name=wong/><ref name=rimbach/>
LimitationsEdit
In 2001, Rimbach et al. reported in a large multicenter study involving 367 patients on the limitations of the procedure.<ref name=rimbach>Template:Cite journal</ref> Problems were encountered in the ability to enter the tubes, and, even when tubes were cannulated, light reflexions or "white out" from healthy tissue as well as adhesions turned out to be a major problem.<ref name=rimbach/> Thus, the investigators were able to fully examine tubes in only 2 out of 3 cases; perforations occurred in about 4% of cases. Since then, interest in falloposcopy has declined and few studies have been published.Template:Citation needed
The procedure is not usually used in the United Kingdom.<ref name="NICE">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>