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Tzabari et al. Mini-invasive Surg 2018;2:9 I http://dx.doi.org/10.20517/2574-1225.2018.11 Page 3 of 5

[6]
Figure 1. The triple balloon catheter - deflated balloons (cited from Weichselbaum and Stark with permission)

Figure 2. The triple-balloon catheter - inflated balloons (frontal anchor balloons and two elongated dilating balloons) (cited from
[6]
Weichselbaum and Stark with permission)

solution. Both elongated dilating balloons are then inflated simultaneously at each end of the cervical canal
(internal and external Os) by injections of 2.5 mL saline through the “dilation channel”. The surgeon can
control the inflation rate and dilate the cervix gradually according to the resistance created. The inflation
of the dilating balloon takes around 10 s, and the inflated balloons stay in the cervical canal up to 7 min
depending on the needed diameter [Figure 2]. In the next stage, saline solution is injected into the cervical
canal between the two dilating balloons through the “infusion channel” for washing and lubricating of the
cervix. For catheter removal, the balloons are deflated. For the final cervical diameter assessment, the cervix
is measured again by calibrated Hegar rods.

The device was used in 15 women at the Yoseftal Hospital in Eilat, Israel in patients where dilatation of the
cervix was indicated for various procedures. The study was approved by the Hospital Ethical Committee
and all participants signed informed consent form. The aim of the study was to find out if the triple balloon
catheter could be a valid alternative to the traditional dilatation with Hegar rods.

Procedure started with patients in lithotomy position, thorough cleaning of the vulva and the vagina. After
the patient was covered, speculum was inserted, the upper part of the cervix was grasped with tenaculum
forceps and the diameter of the cervix was measured with calibrated Hegar rods. The triple balloon
catheter was thereafter inserted into the cervix without difficulties except one case where cervical stenosis
did not enable its insertion. The anchor balloon was inflated and the catheter was gently pulled out until it
was fixed in the optimal position and thereafter the two elongated dilating balloons were inflated and left
in situ for 5-7 min. The cervix was lubricated with saline solution between both dilating balloons and then
the catheter was removed and the diameter of the dilated cervix was measured again with calibrated Hegar
rods.

RESULTS
The details of the clinical outcome are summarized in Table 1. The average age of the patients was
29.1 years. The minimal diameter of the cervix prior to the dilatation was 2 mm and the maximal was
4.5 mm. After the dilatation with the balloon catheter, the minimal diameter of the cervix was measured
as 4.5 mm and the maximal was 9.5 mm. With the exception of one case which was clinically diagnosed as
cervical stenosis, all the needed intrauterine procedures were done without any need for additional dilatation
with other methods.