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Laparoscopic chromosalpingoscopy

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Chromosalpingoscopy - "Best Clinic"

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Moscow, st. Pervomayskaya, d. 42

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Closes after 5 hours 52 minutes

Moscow, st. Pervomayskaya, d. 42

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Closes after 5 hours 52 minutes

Moscow, st. Pervomayskaya, d. 42

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Moscow, Dobryninsky 4th lane, 4

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Moscow, st. People's Militia, 35

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Moscow, st. Udaltsova, 77

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You can also undergo PET / CT examination in Orel, Lipetsk, Tambov, Kursk, Ufa, Belgorod and Yekaterinburg.

The cost of the survey 49 900 rubles. in Yekaterinburg and 45,000 rubles. in other cities (the cost is full, there are no additional fees).

The service is paid by you directly on the day of the examination at the clinic.

From an application for a service to its provision, on average, it takes 1 working day (that is, if you requested a service on Monday, you will almost always receive it on Wednesday).

If you change your mind, you should report your decision in advance.

The survey is carried out with a radioactive marker 18 FDG.

You will receive the results in paper form and on disk in 3-4 hours.

The duration of the survey is 2-4 hours.

If you are interested in this version of the survey, please leave a request:

Thanks for writing. Your application will be processed in the shortest possible time.
Date and time of reception will be further confirmed when you call back to you.

Anesthesiologists

Equipment

The narcotic and respiratory apparatus Draeger Primus is an indispensable assistant to the anesthesiologist, which allows doctors to fully concentrate on the operation. Many modes of operation provide for the effective use of the device in any clinical picture.

Portable, compact, with retractable handle for transportation. Works from the accumulator and from an electric network. It is used for all age groups of patients, both in the intensive care unit and in the operating room, as well as during patient transportation.

Photo

Training

Given that chromosalpingoscopy is an invasive procedure that is performed under general anesthesia, a comprehensive examination is required at the preparatory stage, which includes:

general clinical analysis of blood and urine,

blood chemistry,

microscopic examination of the vaginal microbial flora,

cytological analysis of cervical epithelium scraping,

assessment of blood coagulation activity

definition of Rh and ABO accessories,

research on blood-borne infections - HIV, syphilis, hepatitis B and C,

fluorography of the lung tissue,

If these studies did not reveal significant abnormalities that are contraindicated for surgery, the surgeon, together with the patient, selects the optimal date for the diagnostic procedure. Immediately before chromosalpingoscopy should:

for 2-3 days to refrain from eating foods that lead to increased gas formation in the intestines (legumes, kefir, cottage cheese, fresh fruits and vegetables, rye bread, etc.),

on the evening before the operation, make a cleansing microclysters containing mild laxatives,

shave pubic hair and over the white line of the abdomen.

The procedure is performed in the morning on an empty stomach, before it is carried out it is not allowed to drink even water.

Conducting hrosalpingoscopy

Chromosalpingoscopy at Best Clinic is performed under endotracheal anesthesia, and in patients with severe somatic diseases under long-term epidural anesthesia.

A special cap is worn on the cervix with a probe carried into the uterine cavity. With the help of a syringe, the doctor creates a vacuum that provides intimate contact between the cap and the cervix. After this comes the laparoscopic stage. The gynecologist conducts a visual assessment of the pelvic organs, which can reveal various abnormalities - endometrial foci, ovarian cysts, adhesions, etc. Then, a dye is introduced through the mother probe in a volume of 10–15 ml.

results

If the pipes are passable, their blue coloration first appears, which gradually spreads to the fimbrial region and appears in the abdominal cavity.

When obstructed patency of the coloring matter in the abdominal cavity comes with a delay - only after 5-10 minutes. This condition may be due to adhesions, excessive length of the fallopian tubes, or stenosis of their exit section, which most often develops after inflammatory processes.

Obstruction may be due to lesions of various sections of the fallopian tubes. Medical tactics also depend on it:

obstruction in the fimbrial section - indication for a single-step dissection of adhesions,

obstruction of the ampullary part is eliminated by salpingolysis (destruction of adhesions) and early hydrotubation on the first day after the operation,

obstruction in the interstitial part is practically not treatable, therefore the only way out is assisted reproduction methods.

Contraindications and effects

Chromosalpingoscopy is not performed in these cases:

acute inflammatory process in the body, incl. with localization in the genitals,

exacerbation of chronic pathology,

uncompensated hypertension and diabetes,

impaired blood clotting.

Laparoscopy with chromogysterosalpingoscopy does not lead to the formation of adhesions. On the contrary - this manipulation provides the possibility of simultaneous dissection. In parallel, the removal of identified ovarian cysts can be performed.

Doctor's advice and recommendations

Gynecologists warn that with hromogysterosalpingoskopii in 30-40% of cases false-negative results can be obtained, i.e. in fact, the pipes are passable. Such diagnostic errors are associated with the individual reaction of the woman’s body to the contrast injected when the fallopian tubes spasm reflexively.

In some cases, the cause of false results may be the presence of thick mucus in the cervical canal, which closes the lumen of the probe. Therefore, gynecologists at Best Clinic recommend chromosalpingoscopy on the 7-8th day of the menstrual cycle.

other services

At Best Clinics, pregnant women are conducted by attentive and experienced obstetricians and gynecologists. The diagnostic program conforms to state standards. It includes the necessary laboratory tests, ultrasound, genetic screening, dopplerometry, fetal CTG and other studies. The clinic is equipped with its own laboratory, so you will be able to pass a medical examination and necessary examinations in one place, without queues and waiting for long results.

Adrenogenital syndrome - a hereditary disease associated with disorders of the adrenal glands. The result of the pathology of AGS is excessive production of androgen hormones in the body, which leads to a change in appearance and physiology: a woman in this case acquires the characteristic male features.

This condition causes psychological distress and is often accompanied by infertility, so the disease must be treated. Girls, whose treatment began in childhood, do not differ much from their peers and give birth to children.

Gynecologists and endocrinologists at Best Clinics have considerable practical experience in effectively correcting the hormonal background and restoring their reproductive function in ACS, so we asked them to answer questions from parents who are faced with hereditary adrenogenital syndrome.

Chromosalpingoscopy (hydroturbation)

Chromosalpingoscopy is one of the methods of hydrotubation - filling the fallopian tubes with fluid through the uterus.

This method is used to assess the patency of the lumen of the fallopian tubes in the diagnosis of tubal infertility. In addition, chromohydrotubation is used to monitor the effectiveness of laparoscopic surgical interventions in order to eliminate tubal infertility.

The essence of the method consists in filling the uterus and fallopian tubes with dye. In this case, the substance should normally flow into the abdominal cavity from the fimbrial end of the fallopian tube. If this does not happen, the pipe is impassable.

As a coloring agent, an indicator, use sterile saline mixed with indigo carmine or methylene blue. The study is desirable to conduct from the 8th to the 24th day of the menstrual cycle. Anesthesia is not required, enough local anesthesia.

The study is conducted through two approaches - laparoscopic and vaginal. Immediately before chromosalpingoscopy, the patient empties the bowels and bladder. In the paraumbilical region, a Veress needle is punctured, through which carbon dioxide is injected into the abdominal cavity. Then, through this puncture, a trocar and a laparoscope are inserted. If, in addition to the chromohydrotubation, any manipulations on the tubes are planned, make 2 additional openings on both sides in the iliac region.

External genitals are treated with iodine-containing antiseptic. The front lip of the external uterine chase is captured and fixed with bullet forceps. Then a special device is inserted into the lumen of the cervical canal - the uterine cannula. A syringe is connected to the outer end of the cannula with a sterile indicator that is inserted into the uterine cavity. Already by how easily the piston moves, one can indirectly judge the patency of the pipes.

Next, under the control of a laparoscope, an indicator is poured into the abdominal cavity. The absence of the indicator indicates a blockage of the lumen of the tube due to the inflammatory-adhesions process. The final stage is the toilet of the abdominal cavity with antiseptic solutions. In a number of cases, hydrochlorotubation has not only diagnostic, but also therapeutic value. Sometimes, under the action of passing fluid, the adhesions in the pipe are separated, and the pipe permeability is restored.

When does the formation of adhesions occur?

Clusters are most likely to appear under the following conditions:

  • Infectious or traumatic lesions of the abdominal organs.
  • Abdominal surgery, whose spectrum is constantly expanding.

It was established that adhesions are formed when fibrinolysis is violated, and the immunoreactive nature of adhesions is not excluded.

Now scientists are talking about a possible genetic predisposition to the development of adhesive disease in some people.

Manifestations of adhesive disease

The disease may be asymptomatic and not cause any inconvenience, until it significantly affects the function of the internal organs. A clinic of adhesive disease may appear in the first month after surgery or injury, or it may not manifest itself for many years.

Most often, the symptoms leading to a visit to a doctor are a clinic of intestinal obstruction.

With adhesive disease, pain can occur in various parts of the abdomen.

It manifests itself adhesions pain in the abdomen. They can provoke the appearance of several types of intestinal obstruction:

  • Obstructive obstruction. In the form of obstruction, the passage of intestinal contents is impaired due to the narrowing of its lumen as a result of compression by adhesions, but the circulation of the organ is not affected. There are paroxysmal abdominal pain associated with peristalsis, later vomiting joins. The abdomen of the patient is swollen, delayed stool develops The doctor may notice an increase in peristaltic noise, sometimes peristalsis may be visible through the anterior abdominal wall.
  • Strangulation obstruction. As a result of the appearance of pathological adhesions, the mesentery of the intestine is squeezed, which can quickly lead to organ necrosis. At the same time, the patient against the background of complete well-being appears severe abdominal pain, vomiting, after which usually follows a period of “imaginary well-being”, when pain is not disturbed, but the general condition continues to worsen, symptoms of intoxication appear. This type of obstruction is an indication for emergency surgery.

If there are no intestinal obstruction phenomena, diagnostic methods such as an ultrasound scan of the abdominal cavity, computed tomography, magnetic resonance imaging help the doctor to determine the adhesive disease.

Doctors check a lot of symptoms during a physical and X-ray examination in order to clarify their diagnosis, and proceed to treatment aimed at eliminating adhesions and therapy of acute intestinal obstruction.

Getting rid of adhesions

The need for surgery may occur during an acute attack of intestinal adhesive obstruction

Depending on how soon after the injury, operation or infection process the adhesive disease clinic has appeared, the treatment tactics will differ. Spikes:

  • Those that appear during the first week on the background of intestinal paresis are treated conservatively. The main task here is to restore the normal functioning of the intestines as soon as possible.
  • Appearing during the first weeks after surgery or trauma in the early stages may be amenable to conservative treatment, at the clinic of intestinal necessity surgical intervention is necessary.
  • Formed after a month or more after exposure and having a bright clinic of intestinal obstruction are treated promptly.

For a long time, the main method of treatment of adhesive disease was open laparotomy with dissection of adhesions. But there were no guarantees that this would prevent the further formation of adhesions.

It is a laparoscopic operation that can not only confirm the presence of adhesions in a patient, but also immediately eliminate it, causing minimal damage. This type of diagnosis and treatment of patients with a clinic of intestinal obstruction is especially important.

The formation of adhesions

The physiological mechanisms of fibrinolysis usually dissolve fibrinous overlays in periods from 72 to 96 hours after injury. Restoration of the mesothelium usually occurs within 5 days after injury. Separate cells of the mesothelium cover the damaged area, replacing fibrinous exudate. However, if the fibrinolytic action of the peritoneum is suppressed, the fibroblasts will migrate, spread and form fibrous adhesions with the deposition of collagen and the proliferation of blood vessels. Factors that suppress the fibrinolytic effect and support the formation of postoperative adhesions.

The formation of postoperative adhesions

Microsurgery involves the use of optical magnification, gentle treatment of tissues and constant irrigation, careful hemostasis, the use of microsurgical instruments and areal suture material, an exact comparison of tissues. The fertility restoration operations performed by laparotomic access often lead to the formation of new adhesions even with the use of appropriate microsurgical techniques and materials.

Repeated formation of adhesions is detected in 37–72% of the wound surface area, in 51% of patients new adhesions appear after a laparotomy performed on infertility.

Several experimental and clinical studies compared the postoperative formation of adhesions after surgical laparoscopy and laparotomy for infertility. With few exceptions, operating laparoscopy less often led to relapses and the formation of new adhesions.

These results do not contradict the observations made a century ago by T. Debrowski and C. Franz, later confirmed by Ellis. The authors reported that small peritoneal lesions, similar to those found in the operating laparoscopy, heal without the formation of adhesions.

The value of additional procedures

Although microsurgical techniques and operative laparoscopy reduce the likelihood of adhesions formation, the benefits derived from various additional interventions are not proven, despite their widespread use in clinical practice. However, with a few exceptions, they are not sufficiently effective, which is necessary for unconditional acceptance of them into wide practice.

Steroids and antihistamines are rarely used because of their dubious efficacy and potential side effects (slow wound healing, risk of seam divergence).

Dextran 70, high molecular weight dextran, is absorbed from the abdominal cavity within 7-10 days. Due to the osmotic effect, the liquid enters the abdominal cavity, ensuring the floating of moving organs, reducing the likelihood of their sticking and adhesion. Although the study of the effect of the drug showed that dextran-70 prevents the formation of postoperative adhesions, contradictory results limit its use. In addition, there are reports of allergic reactions, various infections and complications associated with fluid overload.

Methods using the barrier function are more promising, since they separate the peritoneal surfaces and prevent the fixation of various structures among themselves. Существует два таких материала: Interceed (Johnson&Johnson, Arlington, TX) — абсорбируемая ткань оксидированной восстановленной целлюлозы, и Gore-Tex (W.L. Gore and Associates, Inc., Flagstaff, AZ) — неабсорбируемая ареактивная хирургическая мембрана.The latter was previously used to restore the integrity of the pericardium and peritoneum.

Two studies presented 134 and 63 patients, respectively. Interceed was placed on one of the two side walls of the pelvis at the final stage of the operation. With repeated laparoscopy, it was found that approximately 2 times more often (51% vs. 24%) when using Interceed, the pelvic side wall was free of adhesions (compared with the opposite side).

These observations were continued in another 4 studies, where surgeons wrapped one of the ovaries with Interceed material, and 168 patients were examined. The ovaries were free from adhesions on the side of Interceed application 2 times more often than on the opposite side.

Similar data were obtained for the Gore-Tex material.

Judging by these data, it seems that the barrier method using absorbable or non-absorbable material is safe and effective for preventing postoperative adhesions.

It should always be remembered that in the prevention of adhesive disease there is no alternative to a cautious and gentle surgical technique.

Causes and signs of pathology

Adhesions are usually formed in the abdominal or pelvic cavity after operations in these areas. Anomaly can also be the result of a serious inflammatory process in the body (appendicitis, endometriosis, diverticulitis).

In some cases, spikes do not cause a person to worry. If they affect the normal functioning of the internal organs, interfering with it, they talk about adhesive disease. Pathology can lead to acute intestinal obstruction and infertility. Often the disease is accompanied by severe abdominal pain. Such indications are absolute indications for adhesiolysis surgery.

Surgical adhesions dissection

Adhesiolysis is performed mainly by the laparoscopic method. Laparoscopy provides the most rapid recovery of the patient after surgery and is the least traumatic intervention.

  1. Access to the adhesions is due to several punctures in the abdominal wall, through which the manipulators of the laparoscope (forceps, scissors, aspirator) and the camera are inserted.
  2. To create a working space in the body cavity, pre-pumped gas raising the abdominal wall.
  3. The adhesions are successively grasped with forceps, dissected as close as possible to the organs and removed.
  4. Damaged vessels are immediately coagulated with a laser or electrodes.
  5. It is necessary to ensure the constant dryness of the surgical field with an aspirator.

What is important to pay attention after the procedure?

  • Sometimes after surgery, the patient feels pain in the subclavian region. Usually the pain goes away within a few days.
  • The stitches are removed after a week.
  • To mental work can be a few days. Restoration after laparoscopy depends on the volume of the operation, but most often lasts no more than 4 weeks.

Indications and contraindications

Indications for this intervention are suspected tubal infertility and the need to evaluate the effectiveness of surgical treatment of tubal infertility. As indications of possible tubal infertility requiring chromosalpingoscopy, consider the absence of pregnancy in combination with signs of adhesions and occlusion of the lumen of the fallopian tubes according to other studies, salpingitis, pyosalpinx and tubal pregnancy in history.

Contraindications to chromosalpingoscopy are acute and chronic renal and hepatic failure, decompensated diseases of the respiratory and cardiovascular systems. The list of contraindications for chromosalpingoscopy also includes coagulopathy, which is not amenable to medical correction, oncological lesions of the female genital organs, pregnancy, adhesions against the background of previous surgical interventions on the pelvic organs and the abdominal cavity. Chromosalpingoscopy is not performed during the period of acute respiratory diseases and for 4 weeks after the disappearance of the symptoms of these diseases, with III and IV purity of the vagina, specific and non-specific infections of the external genital organs and allergy to the coloring drug (methylene blue, indigo carmine).

Methodology

The specialist processes the external genitals, vagina and cervix, then puts a cap on the neck, provides a seal between the cervix and the cap, sucking the air with a syringe, and inserts a hollow probe into the cervical canal. Then the doctor goes to the endoscopic stage of chromosalpingoscopy. He performs a puncture in the umbilical region with a Veress needle, pumps carbon dioxide into the abdominal cavity, and then inserts a laparoscope through the puncture. In the presence of postoperative scars in the navel, the puncture site is changed for chromosalpingoscopy, taking into account the alleged localization of adhesions.

For revision of the abdominal cavity and organs of the small pelvis and additional manipulations in the zone of internal genital organs with chromosalpingoscopy, two additional trocars are introduced in the iliac regions. The doctor first examines the abdominal cavity to prevent accidental damage during the first puncture, and then conducts a visual inspection of the internal genital organs, assessing the size, shape, location and condition of the uterine serosa, length, shape and location of the fallopian tubes, size, shape and surface condition ovaries.

Then the main stage of chromosalpingoscopy begins. The assistant, through a probe, injects 10-15 ml of sterile saline mixed with indigo carmine or methylene blue into the uterine cavity. The colored fluid spreads through the pipes, while the endoscopist can track the speed of its progress by changing the color of the organs. After some time, the dye begins to stand out from the fimbrial end of the fallopian tubes. Chromosalpingoscopy allows the physician to assess the degree of patency of the pipes, taking into account the dynamics of the discharge of colored fluid. Then the specialist flushes the abdominal cavity with an antiseptic solution, removes the endoscope and stitches the puncture area.

After chromosalpingoscopy

The duration of hospitalization is several days. The patient is observed, if necessary, anesthetics and antibacterial agents are prescribed. The extract is carried out after the normalization of the general condition. Complications with chromosalpingoscopy are rare. Possible complications include bleeding, wound infection, carbon dioxide penetration into other cavities and tissues with the exception of the abdominal cavity, gas embolism, damage to the abdominal organs and large retroperitoneal vessels. In case of damage to the digestive tract and retroperitoneal vessels, urgent laparotomy is necessary.

Interpretation of results

When conducting chromosalpingoscopy, the degree of patency of the fallopian tubes is assessed by a five-point system:

  • 5 points - the dye begins to freely, in a wide stream, stand out from the fimbrial end of the tube in 1-3 seconds after the injection.
  • 4 points - the delay in the release of fluid during chromosalpingoscopy is 2-5 seconds. Observed jet selection of the dye.
  • 3 points - the delay between the introduction of the dye and its release from the tube is 5-10 seconds. There is a significant increase in the volume of the pipe, the liquid comes out of the fimbrial end with fast drops.
  • 2 points - during chromosalpingoscopy a significant delay in the release of fluid is detected, the dye is released by slow drops. Sometimes for the appearance of fluid in the pelvic cavity it is necessary to reintroduce the coloring matter in the uterus.
  • 1 point - there is sweating of the liquid through the fimbrial fallopian tube.
  • 0 points - there is no coloring fluid in the small pelvis; in the region of the fimbrial end of the tube, adhesions are determined.

The prognosis and tactics of tubal infertility treatment are determined depending on the number of points scored during chromosalpingoscopy. With 4-5 points, tubal infertility is not diagnosed, in the absence of other diseases and pathological conditions, pregnancy is possible without additional therapeutic measures. 2-3 points on the results of chromosalpingoscopy is considered as an indication for salpingolysis or plastic surgery of the tube, after treatment the prognosis is favorable. At 1-2 points, plastic tube or neosalpingostomy is necessary, the prognosis is dubious. At 0 points, surgical repair of the tube is ineffective; in vitro fertilization and embryo transfer are required.

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