Hydrosalpinx at laparoscopy — operative decision-making station

Procedural decision-making station: intraoperative findings of a hydrosalpinx at laparoscopy before IVF. Tests the candidate's operative decision (salpingectomy versus proximal occlusion versus aspiration), ovarian-sparing technique, handling of the contralateral adhesions, and communication with the consultant. Includes assessor key, marking domains and fail criteria.

Prompt

A 31-year-old woman with tubal-factor infertility is undergoing a planned diagnostic-and-therapeutic laparoscopy before IVF. She has a history of chlamydia and an HSG showed a right hydrosalpinx. On entering the abdomen you find a large right hydrosalpinx with densely adherent fimbriae and a left tube that is patent but shows peritubal adhesions. You are the registrar with the consultant on speakerphone.

Station brief

Format. Operative decision-making station, approximately 12 minutes. You are the registrar in theatre. A scrub nurse and anaesthetist are with you; the consultant is on speakerphone, 15 minutes away. The assessor feeds intraoperative findings and watches your decisions.^[3]

Candidate instruction. Manage the operative findings, verbalise your decisions with reasoning, preserve ovarian function, deal with the contralateral adhesions, and communicate clearly with the team and the consultant.^[1]^[3]

References5Show

[1]Melo P, Georgiou EX, Johnson N, et al. Surgical treatment for tubal disease in women due to undergo in vitro fertilisation Cochrane Database Syst Rev, 2020.PMID 33091963
[2]Zeyneloglu HB, Arici A, Olive DL Adverse effects of hydrosalpinx on pregnancy rates after in vitro fertilization-embryo transfer Fertil Steril, 1998.PMID 9757878
[3]Capmas P, Suarthana E, Tulandi T Management of Hydrosalpinx in the Era of Assisted Reproductive Technology: A Systematic Review and Meta-analysis J Minim Invasive Gynecol, 2021.PMID 32853797
[4]Strandell A, Lindhard A, Waldenström U, et al. Hydrosalpinx and IVF outcome: cumulative results after salpingectomy in a randomized controlled trial Hum Reprod, 2001.PMID 11679529
[5]Dreyer K, van Rijswijk J, Mijatovic V, et al. Oil-Based or Water-Based Contrast for Hysterosalpingography in Infertile Women N Engl J Med, 2017.PMID 28520519

Hydrosalpinx at laparoscopy — operative decision-making station

Station brief

References5Show

[1]Melo P, Georgiou EX, Johnson N, et al. Surgical treatment for tubal disease in women due to undergo in vitro fertilisation Cochrane Database Syst Rev, 2020.PMID 33091963
[2]Zeyneloglu HB, Arici A, Olive DL Adverse effects of hydrosalpinx on pregnancy rates after in vitro fertilization-embryo transfer Fertil Steril, 1998.PMID 9757878
[3]Capmas P, Suarthana E, Tulandi T Management of Hydrosalpinx in the Era of Assisted Reproductive Technology: A Systematic Review and Meta-analysis J Minim Invasive Gynecol, 2021.PMID 32853797
[4]Strandell A, Lindhard A, Waldenström U, et al. Hydrosalpinx and IVF outcome: cumulative results after salpingectomy in a randomized controlled trial Hum Reprod, 2001.PMID 11679529
[5]Dreyer K, van Rijswijk J, Mijatovic V, et al. Oil-Based or Water-Based Contrast for Hysterosalpingography in Infertile Women N Engl J Med, 2017.PMID 28520519