Author(s): Tsin DA, Mahmood D
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Abstract The laparotomy approach for microsurgical repair of tubo-tubal anastomosis is a well-established method. This article describes a novel technique of end to end tubo-tubal re-anastomosis using the minimally invasive methods of video laparoscopy, video hysteroscopy, and lasers in four women. This procedure is applicable to women of reproductive age who have previously been subjected to voluntary sterilization procedures. The long-term results of this new technique remain to be evaluated. However, the minimal surgical approach has met with early success and patient approval. PIP: The laparotomy approach for microsurgical repair of tubo-tubal anastomosis is well-established. A novel technique of end-to-end tubo-tubal re-anastomosis using the minimally invasive methods of video laparoscopy, video hysteroscopy, and laser in 4 women in described. All 4 women were of reproductive age, had been sterilized, and wanted a reversal of sterilization. A traditional work-up was performed on each involved couple. When possible, a hysterosalpingogram was done. The procedure was performed during the proliferative phase shortly after menses. The patients were given a bowel prep with a liquid diet for 2 days; a laxative was given the day before surgery and laminaria medium thick was inserted into the cervix. The patient received iv antibiotics immediately before operation, and general anesthesia was used. After induction, the laminaria was removed, pelvic examination performed, and a uterine cannula was inserted for manipulation and perturbation. If tubal occlusion was to be established, normal saline was injected via the uterine cannula. If peritoneal spillage occurred, the tubes were patent. As no spillage occurred, tubal occlusion was confirmed. The tubes were then observed to see if an endoscopic tuboplasty could be performed. The tube was cannulated through the fimbria, and the catheter was passed until it bordered the level of the obstruction. The blocked end was then cut, utilizing a laparoscopic scissor and bipolar coagulation for bleeders. Occlusions secondary to sterilization procedures cannot be undone via hysteroscopy, falloscopy, or other glide wire techniques. Such patients were candidates for in vitro fertilization of laparotomy with microsurgical repair. The minimal surgical approach has met with early success and patient approval. The longterm results of this technique remain to be evaluated.
This article was published in J Laparoendosc Surg
and referenced in Reproductive System & Sexual Disorders: Current Research