Laparoscopic Tubal Reanastamosis

Abstract

<h3>Study Objective</h3> We aim to demonstrate a laparoscopic technique for tubal reanastomosis. We include two patients who have undergone bilateral tubal ligation, in addition to demonstrating modifications to the surgical approach based on intraoperative findings. <h3>Design</h3> Video presentation of a laparoscopic tubal reanastomosis technique. <h3>Setting</h3> Academic medical center. <h3>Patients or Participants</h3> The first patient is a 41yo G3P1021 who had undergone bilateral tubal ligation with falope rings. The second patient is a 36yo G3P1021 who had previously undergone bilateral tubal ligation with fulguration. Both patients desired reversal of tubal ligation for future fertility. <h3>Interventions</h3> The steps of a laparoscopic tubal reanastomosis are described in this video. The procedure includes performing a diagnostic laparoscopy. Next, the portion of the proximal tube is transected with cold scissors until healthy tissue is exposed. Subsequently, chromopertubation is performed to ensure proximal patency. The most proximal portion of the distal tube is then transected to expose healthy tissue. The proximal tube is then sutured to the distal tube at 4 cardinal points using 4-0 or 5-0 vicryl suture. Repeat chromopertubation is then performed to confirm tubal patency. The first patient demonstrates the technique for laparoscopic tubal reanastomosis, while the second patient displays modifications for potential complications, such as proximal tubal occlusion and a broad ligament defect. <h3>Measurements and Main Results</h3> N/A. <h3>Conclusion</h3> Laparoscopic tubal reanastomosis is a minimally invasive surgical option for patients that wish to conceive after a prior tubal ligation and desire an alternative to IVF. The goal is to remove abnormal tissue from the prior sterilization and reapproximate healthy tubal remnants to establish tubal patency and achieve another chance at spontaneous conception. We demonstrate a technique for laparoscopic tubal reanastomosis, as well as intraoperative modifications for potential complications.