Ovarian capsular drilling in the treatment of clomiphene citrate resistant polycystic ovarian syndrome: Laparoscopy or hydrolaparoscopy
Background: Laparoscopic Ovarian Drilling (LOD) is an effective and a well evaluated surgical Treatment of Clomiphene Citrate resistant Polycystic ovarian syndrome. Transvaginal hydrolaparoscopy (TVHL) is a relatively new simple method of exploring the pelvis and has recently been introduced as a transvaginal approach to ovarian capsular drilling and it seems promising.
Objective: To explore whether the newly introduced Transvaginal Hydrolaparoscopy (TVHL) will have a significant advantage over the standard laparoscopy (SL) for Laparoscopic Ovarian Drilling (LOD) in Women with polycystic ovarian syndrome.
Methods: Published literature in English language was retrieved through searches of Pubmed, Highwire and Google using appropriate controlled vocabulary and key words. The articles that met the review criteria were selected and the relevant references screened.
Results: All the studies agreed that Transvaginal Hydrolaparoscopy (TVHL) is as effective as Standard Laparoscopy (SL) for ovarian drilling in polycystic ovarian syndrome. Unlike Standard laparoscopy, TVHL can be performed under local anesthesia as an office procedure. Postoperative adhesions are less in TVHL than SL and pregnancy rate is slightly higher. However, incomplete view of the pelvic structures and the requirement of ultrasound guidance were some setback when compared to the standard laparoscopy.
Conclusions: In experienced hands, TVHL is a good alternative to SL. TVHL has the possibility of replacing SL as more Minimal Access Surgeons become more comfortable with the technique.
Key words: Transvaginal Hydrolaparoscopy, Standard Laparoscopy, Ovarian Drilling