Etiology of Proximal Tubal Obstruction.
Fallopian Tube Recanalization Techniques.
Summary of Results Following Various Endoscopic Fallopian Tube Recanalization Techniques.
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Despite the diagnostic superiority of falloposcopy in the visualization of endotubal disease and in vivo exploration of tubal physiology and its therapeutic advantages, technical shortcomings associated with falloposcopy (e.g., white-out due to the intense light in close proximity of tissues, kinking leading to catheter damage and impediment of successful falloposcope insertion) as well as personal expertise required with the technique, limit the usefulness of this method in routine clinical practice. Hence, we envisage a robotically assisted hysteroscopic–falloposcopic FTR technique under ultrasonic vision using the atraumatic Cook echotip embryo-transfer catheters to facilitate visualization and cannulation. While overcoming the necessary technical shortcomings associated with the technique, a robotically assisted manipulation would facilitate the catheter maneuver along the tortuous trajectory of the proximal Fallopian tube. Ultrasound-guided cannulation would help map the catheter path, avoiding tubal perforations during guidewire cannulation. The micromanipulation could alternatively be simulated on a monitor akin to that used for intracytoplasmic sperm injection. The use of thermally controlled catheters/guidewires may present the possibility of effectively clearing fibrotic occlusions that have so far evaded recanalization.