Tubal patency is often required to detect cause of infertility in female of reproductive age group.
It appears that the laparoscopic approach has several advantages:
1. Cosmetically better outcome.
2. Less tissue dissection and disruption of tissue planes
3. Less pain postoperatively.
4. Low intra-operatively and postoperative complications.
5. Early return to work.
Laparoscopic tubal patency test in expert hands is now safe and effective. The public needs to be educated as to its advantages. All surgeons agree that for women of child bearing suffering with infertility, laparoscopic test for tubal patency is unquestionably the method of choice.
Laparoscopic tubal patency test is a safe procedure, and can provide less postoperative morbidity in experienced hands. With better training in minimal access surgery now available, the time has arrived for it to take its place in the surgeon’s repertoire.
The general anaesthesia and the pneumoperitoneum required as part of the laparoscopic procedure do increase the risk in certain groups of patients. Most surgeons would not recommend general anaesthesia in those with pre-existing disease conditions. The laparoscopy tubal patency test under local anesthesia should be performed in those cases. Patients with Cardiac diseases and COPD should not be considered a good candidate for laparoscopy. The laparoscopic tubal patency test may also be more difficult in patients who have had previous lower abdominal surgery.
First of all do diagnostic laparoscopy to exclude any other abnormality. If everything is all right then go for next step of tubal patency test.
1. Cannulate the cervix with a Sprackrnan cannula, connected to a syringe containing 20 ml of saline with methylene blue dye.
2. Ask the assistant to injects the methylene blue dye through the cervix. Some back spillage of dye may occur as the dye passes up the uterus, along the fallopian tube and escapes from the fimbrial end.
3. The dye may sometimes cause tubal spasm, so small pressure spurts should be used.
4. With gentle manipulation of pelvic structures the exterior aspects of the tube and its patency should be assessed. Mobility and fimbrial architecture should be identified.
1.Examine the abdomen for any possible bowel injury or haemorrhage.
2.Remove the telescope.
3.Remove telescope leaving gas valve of umbilical port open to let out all the gas.
4.Close the wound with Suture. Use vicryl for rectus and un-absorbable intra-dermal or Stapler for skin.
5.Apply adhesive sterile dressing over the wound.
If everything goes well the patient can be discharged on the same day. The snapshot pictures and video recording of all the procedure should be performed for future references.
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