Hysteroscopic Tubal Cornual Cannulation

Tubal cannulation is a procedure to open corneal blockages (origin of the fallopian tubes near the uterus).

Hysteroscopic Tubal cornual cannulation (HTCC)

Fallopian tube problems account for about 25-30% of cases of infertility in women and out of this, about 10-15% are having proximal tubal obstruction (PTO) or cornual blockage, which is the blockage of the cornual areas of the uterus. The uterine cornua are the somewhat ill-defined, superolateral portions of the uterine body where the fallopian tubes join on each side. This part of the fallopian tube at the junction of the uterus and the tube is as thin as a hair, and a cornual blockage by mucous plugs or debris can prevent the entry of the sperm inside the fallopian tubes, thus leading to infertility.

Hysteroscopic tubal cornual cannulation is the treatment to remove the blockages in the cornual areas of fallopian tubes and restore tubal patency,

leading to the opening up of the blocked fallopian tubes, and resulting in a successful pregnancy. The only symptom of PTO is infertility, although diagnostic tests have to be undertaken in order to confirm the blockage.

How is it done?

Tubal cornual cannulation with hysteroscopy is helpful for women in whom cornual tubal block is causing infertility. The procedure is done under general anaesthesia in the operating room. First, the uterus is distended with normal saline. After completely visualising the uterine cavity, the hysteroscope which is connected to a high-definition camera and monitor is introduced inside the uterus, and the tubal openings on both sides are located. A fine wire is passed through the hysteroscope and negotiated through these tubal openings in order to remove the cornual block. This cannulates the fallopian tube, removes any blockage caused by either mucous plugs, debris, or tissues. Simultaneous laparoscopy is needed to see the distal end of the fallopian tubes inside the uterus and the patency is assessed by pushing a blue dye from below.

Risk Factors

Tubal cannulation should be done only by medical practitioners well-trained in the procedure since there are risks involved here which include:

  • Failure in making the fallopian tube functional
  • Pinhole tubal perforation, tubal dissection, or tear in the fallopian tube wall
  • Peritonitis, a life-threatening infection of the tissue covering organs in the belly

Hysteroscopic tubal cannulation under laparoscopic guidance has a major impact on the management and counselling of infertile women with PTO. It is a simple and short day-care procedure. Considering the success rate of hysteroscopic tubal cannulation, about three-fourths of the patients with PTO managed by this technique are recommended to try to conceive naturally. Also, since it is generally done with laparoscopy, the presence of distal tubal disease or other pathologies can also be diagnosed and treated simultaneously. Besides, the procedure is cost effective and also does not involve any overnight stay at the hospital after the procedure.