Ebook: The Fallopian Tube: Clinical and Surgical Aspects

The examination of the human fallopian tubes was, until recently, restricted to observations on gross anatomical disposition and tubal patency. These studies, for decades, were the domain of doctors and physiologists whose primary interest was population control and family planning, funded largely by organisations and agencies seek­ ing alternatives to steroidal contraceptives. For a "worrying" but short period after the birth of Louise Brown in 1978 as the conse­ quence of successful in-vitro fertilisation and embryo transfer, the fallopian tube was considered to be "dispensable" given that the metabolic milieu in which human fertilisation takes place could be effortlessly reproduced in a Petri dish, in in-vitro fertilisation procedures. However, a number of factors have acted together to renew in­ terest in the fallopian tube, namely new techniques in cell biology, microinstrument developments (in particular in imaging), an inter­ disciplinary transfer of skills from interventional radiology and car­ diology to gynaecology, the surgeon's wish to improve surgical tech­ niques, and better techniques to monitor early pregnancy. These factors have led surgeons to develop the new diagnostic and ther­ apeutic strategies and techniques listed here. This volume contains contributions from the majority of keynote speakers at a conference held in London in April 1992 from which its title is derived. Better diagnostic procedures should lead to the implementation of rational effective treatments.

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The Fallopian Tube introduces the reader to recent scientific and clinical work on tubal function as viewed by specialists in reproductive medicine and infertility. It forms a backdrop against which the use of new catheterisation instruments, micro endoscopes and interventional radiology can be evaluated. The use of new instruments is described in the diagnosis of tubal disease, in particular that leading to infertility. In addition, the place of tubal gamete/embryo transfer is addressed. Early diagnosis of ectopic pregnancy has permitted a consideration of less aggressive surgical treatment as well as medical treatment only. Pioneers in this field describe their experience and outline new strategies for the treatment of ectopic pregnancy which may lead to less morbidity and therefore a greater chance of subsequent normal pregnancy. The most important feature of the volume is that it presents in a concise and comprehensive fashion authoritative reports on new strategies in the diagnosis and management of tubal disorders. The particular clinical emphasis of the new developments described here such as less invasive, less costly, safe and effective strategies of managing patients with tubal disease will encourage readers to consider reviewing their practice to the benefit of their patients.