Neosalpingostomy
The first step was the injection of methylene blue-saline solution via the hysteroscope. By laparoscopy, a cross-cut was made, using cold scissors, at the thinnest part of the blind-ending fallopian tube, and gently extended up to 1.5 cm in order to form 4 fimbrial flaps. The mucosa was evertedly sutured to the serosal layer with a 4-0 braided absorbable suture and diluted methylene blue was injected in order to access the tubal patency. During the surgical procedure, we tried to be as gentle as possible and continuously flushed wounds with saline in order to reduce unnecessary damage to fallopian tubes (Figure S2-B).
In addition to salpingectomy and neosalpingostomy, co-interventions were allowed including adhesiolysis, cystectomy of ovarian cyst or Mullerian duct cysts, myomectomy, coagulation of endometriosis and resection of endometrial polyps.
A video of the procedure was recorded and stored. Per-operative findings were registered instantly after the surgery, including the presence of Fitz-Hugh-Curtis Syndrome (FHCS),18 leiomyoma, benign ovarian cyst (including mature cystic teratomas, epithelial (serous or mucinous) cystadenoma, Mullerian duct cyst, endometriosis (staged by revised-AFS classification of endometriosis),19adenomyoma, and endometrial polyps. All intra- or postoperative complications were registered.