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Ultraschall Med
DOI: 10.1055/a-2384-4254
Original Article

Fallopian tube catheterization under 3D vaginal ultrasound guidance followed by highly selective hysterosalpingo-foam sonography: an outpatient procedure

Tubenkatheterisierung unter vaginaler 3D-Ultraschallführung, gefolgt von hochselektiver Hysterosalpingo-Schaum-Sonografie: ein ambulantes Verfahren
Yaakov Melcer 
1   Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel
2   OB/GYN, Shamir Medical Center, Tzrifin, Israel (Ringgold ID: RIN37256)
,
Marina Pekar-Zlotin
2   OB/GYN, Shamir Medical Center, Tzrifin, Israel (Ringgold ID: RIN37256)
,
Michal YOUNGSTER
2   OB/GYN, Shamir Medical Center, Tzrifin, Israel (Ringgold ID: RIN37256)
,
Itai Gat
3   Pinchas Borenstein Talpiot Medical Leadership Program, Shamir Medical Center, Tzrifin, Israel (Ringgold ID: RIN37256)
4   Department of Obstetrics and Gynecology, Shamir Medical Center, Tzrifin, Israel (Ringgold ID: RIN37256)
,
Ron Maymon
2   OB/GYN, Shamir Medical Center, Tzrifin, Israel (Ringgold ID: RIN37256)
› Author Affiliations Clinical Trial: Registration number (trial ID): NCT05537805, Trial registry: ClinicalTrials.gov (http://www.clinicaltrials.gov/), Type of Study: Prospective
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Abstract

Purpose

To describe the feasibility of our preliminary outpatient fallopian tube catheterization procedure under 3D vaginal ultrasound (US) guidance followed by highly selective hysterosalpingo-foam sonography (HyFoSy) in infertile women diagnosed with proximal tubal obstruction.

Materials and Methods

A prospective trial was conducted from October 2022 to December 2023. 3D vaginal US was used to establish the precise location of the tip of the selective salpingography catheter at the tubal ostium. A roadrunner was used to cannulate the occluded portion of the fallopian tube. After tubal cannulation, ExEm foam was injected under direct US guidance to confirm tubal recanalization and its passage through the fallopian tubes.

Results

During the study period, a total of 14 women with proximal tubal occlusion underwent this procedure. Tubal patency was achieved in 92.8% of cases. No immediate and remote complications were observed. To date, 3 (21.4%) of the patients conceived after tubal catheterization and 1 had a live birth.

Conclusion

Outpatient fallopian tube catheterization under 3D vaginal US guidance, followed by selective HyFoSy, can be successfully implemented for the diagnosis and treatment of patients with proximal tubal occlusion. The 3D modality allows volume capture of the required acquisition and subsequent post-imaging analysis, thus permitting further examination and study. Additional experience is needed to determine the feasibility of this innovative procedure and to identify the patient subgroups that would benefit the most from this approach.

Zusammenfassung

Ziel

Beschreibung der Durchführbarkeit unserer vorläufigen Methode der ambulanten Tubenkatheterisierung unter vaginaler 3D-Ultraschallführung (US), gefolgt von hochselektiver Hysterosalpingo-Schaum-Sonografie (HyFoSy) bei unfruchtbaren Frauen mit diagnostizierter proximaler Tubenobstruktion.

Material und Methoden

Von Oktober 2022 bis Dezember 2023 wurde eine prospektive Studie durchgeführt. Mittels vaginalem 3D-Ultraschall wurde die genaue Position der Spitze des selektiven Salpingografie-Katheters am Tubenostium bestimmt. Ein Roadrunner wurde verwendet, um den verschlossenen Teil des Eileiters zu kanülieren. Nach der Tubenkanülierung wurde ExEm-Schaum unter direkter Ultraschallkontrolle injiziert, um die Rekanalisation der Tuben und deren Passage durch die Eileiter zu überprüfen.

Ergebnisse

Während des Untersuchungszeitraums wurde dieses Verfahren bei insgesamt 14 Frauen mit proximalem Tubenverschluss durchgeführt. In 92,8% der Fälle wurde die Durchgängigkeit der Eileiter erreicht. Es wurden keine unmittelbaren und langfristigen Komplikationen beobachtet. Bislang wurden 3 Patientinnen (21,4%) nach der Tubenkatheterisierung schwanger und eine Patientin brachte ein lebendes Kind zur Welt.

Schlussfolgerung

Die ambulante Tubenkatheterisierung unter vaginaler 3D-Ultraschallführung, gefolgt von selektiver HyFoSy, kann erfolgreich zur Diagnose und Behandlung von Patientinnen mit proximaler Tubenokklusion eingesetzt werden. Die 3D-Modalität ermöglicht die Volumenerfassung der erforderlichen Daten und die anschließende Bildanalyse, wodurch weitere Untersuchungen und Studien ermöglicht werden. Weitere Erfahrungen sind erforderlich, um die Durchführbarkeit dieses innovativen Verfahrens zu bestimmen und die Patientengruppen zu ermitteln, die am meisten von diesem Ansatz profitieren könnten.

Keywords

Catheterization - Fallopian tube - Proximal tubal obstruction - Catheter/hysterosalpingo-foam sonography - ultrasound


Publication History

Received: 12 June 2024

Accepted: 12 August 2024

Accepted Manuscript online:
12 August 2024

Article published online:
18 December 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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