Compliance and complications of culdotomy.

BACKGROUND: Culdotomy is a practically exclusive appanage of gynaecological surgeons. Today the transvaginal access to pelvis and abdominal cavity is also utilized for non-gynecological surgery. METHODS: The authors report the complications and compliance of 326 culdotomies performed in the Simple Maternity Unit of Asiago Hospital (Asiago, Vicenza, Italy). The casuistry includes 18 adnexetomies, 90 ovarian cysts and fibroids enucleations and/or resections, 23 paraovarian cysts removals, 59 myomectomies, 120 sterilizations, 11 salpingectomies, 1 adesiolysis, 2 ovarian biopsies and 1 abscess drainage. RESULTS: Couldtomy showed to be a procedure with good results in terms of 18 grade 1 and 1 grade IV (5.8%) of Clavien-Dindo grading system for classification of surgical complications, the incidence of conversions in laparotomies, laparoscopies and vaginal hysterectomy (3.1%), the average hospital postoperatory admission (25 hours), low cost of culdotomy compared to laparotomic and laparoscopic surgery; absence of dispareunia and/or other discomforts at long term. CONCLUSIONS: Culdotomy is a simple, proper and alternative route, especially when morcellation is unavoidable.

The cost of out-patient culdoscopy compared to in-patient laparoscopy in women with infertility.

Diagnostic laparoscopy is a common procedure performed in many hospitals worldwide to investigate infertile women. However, morbidity and cost prevent it being considered a first-line diagnostic tool. If out-patient culdoscopy could replace in-patient laparoscopy then a major component of the cost of investigations could be avoided. We studied ten consecutive infertile patients who had laparoscopy under general anaesthesia and another ten patients who had culdoscopy under local anaesthesia in The One Stop Fertility Clinic (OSFC) in The Royal Free Hospital in London. The costs for each patient from both groups was calculated and compared. We found that out-patient investigation in an OSFC produced a saving of over 350 pounds sterling per case or 28% to the hospital compared with in-patient investigation. Although there were other factors which may influence the costs of out-patient culdoscopy, it did provide noticeable savings to the healthcare system.

Investigation of the infertile couple: a one-stop outpatient endoscopy-based approach.

Transvaginal hydrolaparoscopy (THL) is a new culdoscopic technique for exploration of the pelvic cavity that takes advantage of micro-endoscopic technology and uses aquaflotation for inspection of the tubo-ovarian structures. In infertility patients, THL is systematically combined with mini-hysteroscopy, chromopertubation, fimbrioscopy and, when indicated, salpingoscopy. Mini-hysteroscopy in combination with the chromopertubation test allows accurate assessment of the uterine cavity and tubal patency. The transvaginal access combined with the aquaflotation during THL facilitates detailed inspection of the tubo-ovarian structures and detection of subtle pelvic disease. This combined transvaginal endoscopic approach allows complete evaluation of the reproductive tract. THL is better tolerated than hysterosalpingography, less invasive than standard laparoscopy, and can be used safely as a first line investigation of the female partner in a one-stop infertility clinic.