Trans Vaginal Hydrolaparoscopy can Rule Out Ovarian Cancer in High-risk Women Interested to Preserve their Fertility - A Pilot Study

Abstract

Direct visualization of the ovaries and tubal fimbria by Transvaginal hydro-laparoscopy (TVHL), in high-risk Ovarian Cancer (OC), patients, could further support and augment the existing screening tests of early OC diagnosis. Between 2005 and 2017 TVHL and hysteroscopy were performed in 67 asymptomatic patients at high risk of OC, interested to preserve their ovaries and fertility, and denied undergoing preventive bilateral salpingo-oophorectomy (BSO). Forty-five patients had an infertility problem over 6 months and were interested in getting pregnant as soon as possible. All patients had normal Ca-125 and TVU scanning results except in 12 patients an endometrial lesion was detected.

Excellent visualization was achieved in 64/67 (96%) cases examined. The average time of TVHL was 35min. Sixty-two (93%) patients found TVHL a simple and painless procedure. In 3/67 (0.45%) patients one of the two ovaries’ direct visualization was compromised due to adhesions and standard laparoscopy was recommended. In 5/67 (0.75%) cases the clarity was not optimal, and the normal saline injected in the pelvic cavity was exchanged with a fresh one. All patients had cytology of pelvic washing, 25 patients had ovarian biopsies and 13 patient’s tubal fimbria brushing for cytology. One case of epithelial ovarian cancer, one case with a borderline ovarian tumor, three cases with simple and one with complex endometrial hyperplasia were diagnosed after histopathological examination in these selected series of patients.

This pilot study demonstrated excellent patients’ compliance, minimal complication rate, high diagnostic accuracy, and detection of subtle lesions, ability to take ovarian biopsies, tubal fimbrial brushing, and collection of pelvic washings for cytology. The introduction of TVHL to the existing standard Ca 125 and TVU scan screening program for high OC patients interested to preserve their fertility may potentially improve safety and early OC detection. A prospective randomized control trial is needed to prove and support further this proposal.