1 Department of Obstetrics and Gynecology, Tango Central Hospital, Kyoto 627, and 2 Department of Perinatology, Kagawa Medical University, 17501 Ikenobe, Miki, Kagawa 7610793, Japan
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Abstract |
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Key words: Fallopian tube/intrapelvic sonography/laparoscopy/miniature/ultrasound transducer
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Introduction |
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With recent advances in miniaturization of the ultrasound transducer, Goldberg et al. (1991) showed the feasibility of passing flexible catheter-based high-resolution real-time ultrasound transducers into the endometrial canal and Fallopian tube in uterine abnormalities. Potential obstetric and gynaecological applications of intrauterine sonography for systematic examination of the developmental stages of the early embryo or detection of gross embryonic malformations have been reported (Fujiwaki et al., 1995; Kikuchi et al., 1995
, 1996
; Hata, 1996
; Hata et al., 1996
, 1997a
, Hata et al., b
, 1998
).
There are only two reports on the laparoscopic visualization of normal and abnormal human Fallopian tubes using miniature ultrasound transducers (Goldberg et al., 1993; Giordano et al., 1994
). However, image quality was poor because the frequency of the transducer used was 7.5 or 12.5 MHz. Moreover, the size of catheter used in those studies was relatively large (3 or 4.5 mm). The aim of this study was to determine whether laparoscopy-assisted intrapelvic sonography with a highfrequency, real-time miniature transducer is useful for the evaluation of Fallopian tubal texture.
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Materials and methods |
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Prior to each procedure, transvaginal sonography was carried out in all subjects. Under general anaesthesia, after the first trocar (10 mm) was placed on the lower edge of the umbilicus, i.p. pressure was set at 12 mm Hg with CO2 gas, the second trocar (5 mm) was placed at the centre of abdomen below the midline, and the third trocar (5 mm) was placed lateral to the inferior epigastric artery at or below the level of the umbilicus. Both Fallopian tubes were completely soaked with sterile saline effusion. The ultrasonic catheter was then inserted into the peritoneal cavity through the second trocar, and the catheter tip was placed near the Fallopian tubes in the pelvic saline solution. Each tube was displaced using tubal forceps introduced through the third trocar to obtain optimal scanning sections.
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Results |
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Discussion |
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Proximal, distal, and peritubal damage can be caused by a number of pathological processes such as inflammation, endometriosis and surgical trauma. The diagnosis of tubal occlusion relies primarily on hysterosalpingography, hysteroscopy and laparoscopy. A number of innovative diagnostic procedures such as sonosalpingography, Falloposcopy, and selective salpingography improved our ability to accurately diagnose tubal pathology (Confino and Radwanska, 1992). However, tubal function, especially the assessment of endosalpinx is still difficult. In this study, laparoscopy-assisted intrapelvic sonography with a specially developed 20 MHz flexible catheter-based high-resolution, real-time miniature ultrasound transducer depicted clearly endosalpinx in many cases. Therefore, laparoscopy-assisted intrapelvic sonography with a high-frequency, real-time miniature transducer might be a valuable diagnostic modality for the assessment of tubal texure in tubal disorders, possibly in infertility practice. Unfortunately, in the current study, an in-vitro study could not be conducted to confirm that the different layers visualized with ultrasound corresponded with the histological/anatomical findings, because we could not obtain normal fresh specimens of the Fallopian tube after other surgery. Nor could we obtain any data on normal-looking tubes in women undergoing laparoscopic sterilization, because we had no such cases during this period.
With respect to the limitations of laparoscopy-assisted intrapelvic sonography using a high-frequency, real-time miniature transducer, this new technique appears to lack the manoeuvrability, depth of penetration, or field of view necessary to permit evaluation of virtually all common problems. These limitations are likely to be resolved as further technical advances are made.
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Notes |
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References |
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Fujiwaki, R., Hata, T., Hata, K. and Kitao, M. (1995) Intrauterine ultrasonographic assessments of embryonic development. Am. J. Obstet. Gynecol., 173, 17701774.[ISI][Medline]
Giordano, B., Contino, B., Gippa, R. et al. (1994) Use of endolaparoscopic probe in conservative management of Fallopian pregnancy. Ultrasound Obstet. Gynecol., 4, 402405.[ISI][Medline]
Goldberg, B.B., Liu, J.B., Kuhlman, K. et al. (1991) Endoluminal gynecologic ultrasound: preliminary results. J. Ultrasound Med., 10, 583590.[Abstract]
Goldberg, B.B., Liu, J.B., Merton, D.A. et al. (1993) Sonographically guided laparoscopy and mediastinoscopy using miniature catheter-based transducers. J. Ultrasound Med., 12, 4954.[Abstract]
Hata, T. (1996) Intrauterine ultrasonography for the assessment of embryonic development. Med. Imaging Int., 6, 1115.
Hata, T., Fujiwaki, R., Senoh, D. and Hata, K. (1996) Intrauterine sonographic assessments of embryonal liver length. Hum. Reprod., 11, 12781281.
Hata, T., Manabe, A., Makihara, K. et al. (1997a) Assessment of embryonic anatomy at 68 weeks of gestation by intrauterine and transvaginal sonography. Hum. Reprod., 12, 18731876.[Abstract]
Hata, T., Senoh, D., Hata, K. and Miyazaki, K. (1997b) Intrauterine sonographic assessments of embryonic heart diameter. Hum. Reprod., 12, 22862291.[Abstract]
Hata, T., Manabe, A., Aoki, S. et al. (1998) Three-dimensional intrauterine sonography in the early first-trimester of human pregnancy: preliminary study. Hum. Reprod., 13, 740743.[Abstract]
Kikuchi, A., Okai, T., Kobayashi, K. et al. (1995) Intrauterine ultrasonography with a high-frequency probe: preliminary report. Obstet. Gynecol., 85, 457461.
Kikuchi, A., Okai, T., Kobayashi, K. et al. (1996) Intracervical US with a high-frequency miniature probe: a method for diagnosing early invasive cervical cancer. Radiology, 198, 411413.[Abstract]
Tsuda, H., Kawabata, M., Yamamoto, K. and Umesaki, N. (1996) Diagnosis of myometrial invasion of endometrial cancer by intrauterine ultrasonography with a high-frequency probe and fluid contrast augmentation in the uterine cavity: a preliminary study. Br. J. Obstet. Gynaecol., 103, 840841.[ISI][Medline]
Timor-Tritsch, I.E. and Rottem, S. (1987) Transvaginal ultrasonographic study of the fallopian tube. Obstet. Gynecol., 70, 424428.[Abstract]
Submitted on July 9, 1998; accepted on December 2, 1998.