Tubal cannulation is a procedure to open up tubal corneal blocks (origin of fallopian tubes near the uterus). It is done under hysteroscopic guidance (a procedure that allows the Gynaecologist to see inside the womb by means of a fine telescope called Hysteroscope, introduced through the neck of the womb). It involves passage of a fine wire through the hysteroscope into the opening of fallopian tubes.
This part of the fallopian tube at the junction of uterus and tubes, it is as thin as a hair and such a procedure often removes blockage due to mucous plugs or debris, thus restoring tubal patency. Simultaneous Laparoscopy is needed to visualize the distal end of the fallopian tubes and confirmation of their normal status. Laparoscopy is also needed for the passage of guide wire through the tube followed by pushing a blue dye to check whether tube has opened (chromopertubation).
Video of Cannulation
Video of cannulation 2
When is this procedure usually done?
This procedure is done in women who have cornual block (That portion of the tube where it arises from the uterus).
This is usually diagnosed prior on hysterosalpingography. Many a time cornual block may be diagnosed at the time of diagnostic laparoscopy. This procedure is not to be performed if there is a distal tubal pathology.
Is there any alternative to tubal cannulation?
Tubal defect or disease accounts for 25 – 30 % of infertility in women, of which proximal tubal obstruction accounts for 10 –15 % . The traditional treatment for cornual / proximal tubal block is an open surgery and IVF (Test tube baby). Open surgery causes significant patient discomfort, is tedious, time consuming and causes delay in recovery. There incidence of ectopic pregnancies also increases after an open surgery.
Other management option is the use of in vitro fertilization (IVF), but this is, costly, time consuming, with 40-45% success per attempt. On the other hysteroscopic tubal cannulation is a simple and short day care procedure. Also, since it is generally done with laparoscopy the presence of distal tubal disease or other pathologies can also be diagnosed and treated simultaneously. It is cost effective, the results are also comparable with minimal complication and ectopic pregnancy rates. Post procedure pregnancy rates reported in various studies range from 20-40 %. If pregnancy is not achieved in six months after the procedure then tubal patency needs to be confirmed by hysterosalpingogram.
What are the potential complications?
Failure to navigate the tube and open the obstruction can occur in 10-30 % women.
Pinhole tubal perforation or tubal dissection is known to occur in 3.7 % cases.
Other complications which can occur with any hysteroscopic procedure.
There is no increased ectopic pregnancy rate with this procedure as opposed to open or microscopic surgeries.