HSG or previous hysteroscopy & laparoscopy suggesting proximal tubal block and she is advised for hysteroscopic Tubal cannulation for Infertility.

• Shorter Hospital stay.
  
• Earlier return to your routine work.
  
• Cosmetically no scar on abdomen.
  
• Less pain after operation.
  
• Best fertility enhancement & Fertility results following hysteroscopy
  
• Video-live operative file available in CD/DVD for future reference (Transparency about surgical procedure).
  
• Patient discharged within 2-4 hours after procedure.
  
• Patient can resume to her normal routine work within 12-24 hours after the procedure.

1. Lab. Investigation for Surgery (Urine complete & Blood complete, HbsAg, HIV, R.B.S.Etc.); Pelvic Trance vaginal USG report.
   
2. Operation planned from 4th to 10th day of Menstrual Cycle.
   
3. Preparation of local parts.

Diagnostic Hysteroscopy & Laparoscopy is done to confirm the diagnosis of proximal tubal block as blocked tube may turn out to be open in Laparoscopy with HSG reported tubal block is very common.

Patient is given general anesthesia. Patient is put on lithotomy position. Local parts cleaning & paintings with antiseptic solution & draping are done. After P/V examination cervix is checked with uterine sound.

Hysteroscopy requires distention of the uterine cavity with Normal saline to create working space inside the uterine cavity and flushes both fallopian tubes with high pressure fluid also helps in achieving very good fertility enhancing results following Hysteroscopy in infertility patients.

First Diagnostic hysteroscopy is done after removing the air from sheath & hysteroscope (varsascope/1.9 mm/ 2.9 mm) assembled. Hysteroscopy along with irrigation of Normal saline is introduced inside the cavity. Systemically both corneal openings, cavity, both lateral walls and anterior & posterior wall of the uterine wall is noticed for any lesions or normalcy.

Inside the Umbilicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images - and sends them to a monitor so the surgeon can see what is going on inside.

Performing Laparoscopy usually only requires two tiny incisions less than one half cm, (about 3-5 millimeters) in length. One incision is made inside the navel, and another is usually made near the bikini line. The first incision allows a needle to be introduced into the abdomen so carbon dioxide gas can be pumped inside the cavity of the abdomen, which helps to keep intestines & omentum up and away from pelvic organs. This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed.

Observing free spill with diluted betadine (10-50cc) with Wilkinson cannula from the cervix reveals that uterus distends but nothing comes out from both fimbrial ends, which indicated bilateral proximal tubal block. Isthamic tubal part of the fallopian tube is straightened up with grasper and hysteroscopic tubal cannulation is tried from the below.

Cervix is dilated up to 4mm / 5 mm for introduction of Operating hysteroscopic sheath or resectoscope for operative hysteroscopy & hysteroscopic sheath is introduced. After evaluation of both tubal ostia one of the ostial opening is cannulated with tumor guide wire with special catheter loaded on it is gently introduced inside the tubal opening. Under laparoscopic guidance & support and tube straightened up near cornual end laparoscopically & hysteroscopically   guide wire is gently pushed to negotiate proximal tubal block. Then catheter is wedged over guide wire and then guide wire removed and selective salpingiography is done with 10cc of methyline blue and laparoscopically tubal patency checked.

• Patient remains drowsy/sedated for 1-2 hours after hysteroscopy but conscious & pain free.
  
• Patient can take fluids 1-2 hours after hysteroscopy & light food after 2-4 hours. She may feel little discomfort after hysteroscopy for 6-8 hours but it can be relieved with pain killer tabs.
  
• Most of the patients can walk normally without support and can take normal diet 6-8 hours after the hysteroscopy.
  
• She can be discharged on the same day of the operation. Few patients may feel nausea & vomiting after hysteroscopy, which can be very well controlled with injection in post-operative room.
  
• Patient can do her normal activity within 12-24 hours after hysteroscopy.
  
• Patient is advised to take antibiotics & analgesic tabs for 5 days following hysteroscopy.
  
• Patient is advised to report to doctor for severe pain or bleeding or fever in postoperative period (Day-1 to Day-5) immediately.