Laparoscopic Tubal Anastomosis Research Articles

A novel machine learning model for predicting clinical pregnancy after laparoscopic tubal anastomosis

Abstract Background Laparoscopic tubal anastomosis (LTA) is a treatment for women who require reproduction after ligation, and there are no reliable prediction models or clinically useful tools for predicting clinical pregnancy in women who receive this procedure. The prediction model we developed aims to predict the individual probability of clinical pregnancy in women after receiving LTA. Methods Retrospective analysis of clinical data of patients undergoing LAT in the Second Hospital of Lanzhou University from July 2017 to December 2021. Least absolute shrinkage and selection operator (LASSO) regression was used for data dimension reduction and feature selection. We incorporated the patients’ basic characteristics, preoperative laboratory tests and laparoscopic tubal anastomosis procedure signature and obtained a nomogram. The model performance was evaluated in terms of its calibration, discrimination, and clinical applicability. The prediction model was further internally validated using 200 bootstrap resamplings. Results A total of 95 patients were selected to build the predictive model for clinical pregnancy after LTA. The LASSO method identified age, intrauterine polyps, pelvic adhesion and thyroid stimulating hormone(TSH) as independent predictors of the clinical pregnancy rate. The prediction nomogram included the abovementioned four predictive parameters. The model showed good discrimination with an area under the curve (AUC) value of 0.752. The Hosmer‒Lemeshow test of calibration showed that χ2 was 4.955 and the p value was 0.838, which indicates a satisfactory goodness-of-fit. Decision curve analysis demonstrated that the nomogram was clinically useful. Internal validation shows that the predictive model performs well. Conclusion This study presents a nomogram incorporating age, intrauterine polyps, pelvic adhesion and TSH based on the LASSO regression model, which can be conveniently used to facilitate the individualized prediction of clinical pregnancy in women after LTA.

Robotic Assisted Laparoscopic Tubal Anastomosis

<h3>Study Objective</h3> To demonstrate a technique for tubal anastomosis. <h3>Design</h3> A video description of steps of a technique for minimally invasive tubal anastomosis. <h3>Setting</h3> video description of surgical technique using robotic assistance. <h3>Patients or Participants</h3> A 33-years old female with past history of sterilization with partial salpingectomy and no other infertility factors who decided to regain her fertility potential, underwent a laparoscopic tubal anastomosis. <h3>Interventions</h3> Laparoscopic tubal anastomosis with robotic assistance. <h3>Measurements and Main Results</h3> Description of surgical technique using surgical video. <h3>Conclusion</h3> tubal anastomosis using robotic assistance is a reproducible minimally invasive approach.

Effectiveness of laparoscopic tubal anastomosis in tubal occlusion patients after laparoscopic salpingostomy for tubal pregnancy

To evaluate the effectiveness of laparoscopic tubal anastomosis for tubal occlusions associated with infertility in patients with prior laparoscopic salpingostomy for ectopic pregnancy. This study is a retrospective analysis of the pregnancy outcomes of 173 infertile patients who underwent hysteroscopy and laparoscopic tubal anastomosis treatment between January 2013 and August 2018 in the Department of Reproductive Endocrinology in West China Second University Hospital of Sichuan University. All patients had a history of laparoscopic salpingostomy for tubal pregnancy. The primary outcomes were intrauterine pregnancy (IUP), ectopic pregnancy (EP), and delivery (DEL) rates. We further studied the associated factors that could influence the chance in pregnancy status. The 24-month cumulative clinical pregnancy rate of all patients was 107/173 (61.8%). The distribution of outcomes for the entire group of pregnancies was as follows: IUP rate, 76/173 (43.9%); EP rate, 31/173 (17.9%); DEL rate, 68/173 (39.3%); and miscarriage rate, 8/173 (4.6%). Age, type of anastomosis, hydrosalpinx, and endometrial polyp were significant prognostic factors in the multivariate model. Laparoscopic tubal anastomosis is an effective treatment for tubal-associated infertility due to previous laparoscopic salpingostomy for ectopic pregnancy, especially for patients under 35 years of age.

Robotic Assisted Laparoscopic Tubal Anastomosis: Single Institution Analysis

Study Objective To study operative time and cost of robotic assisted laparoscopic tubal anastomosis beyond the learning curve. Secondary objective was to assess pregnancy rate. Design Retrospective Cohort Study. Setting University-affiliated hospital. Patients or Participants All patients who underwent robotic assisted laparoscopic tubal anastomosis from April 2013 to December 2018, performed by a single surgeon at a university-affiliated hospital. Interventions Robotic assisted laparoscopic tubal anastomosis surgery. Measurements and Main Results 109 patients were identified who underwent robotic tubal reversal. Retrospective analysis of EMR was performed. Phone survey was conducted. Operative times were evaluated for 106 cases. Age ranged from 27 to 46 (median 36 ± 4.7), BMI ranged from 18 to 47 (median 29 ± 5.8). Previous ligations included excisional (63%), cautery (13%), and mechanical obstruction (24%). 60% of patients had previous laparotomy. Mean operative time decreased with experience. In 2013, the average operative time was 140.7 ± 27.0 minutes. Average operative time in 2018 was 60.0 ± 9.1 minutes. Downward trend in operative time was highly significant (p The average cost of the surgery was $7,153.46 ± $1,484.41. Direct cost was $4798.25. Follow up information regarding pregnancy outcome was available in 59 patients. Mean follow up time was 37.5 months. 36 patients conceived spontaneously and 23 had not conceived (61%). 75% of patients under 37 became pregnant (n=24), whereas the pregnancy rate was 44% and 45% in the age groups 37-39 (n=7) and >40 years (n=5) respectively. Conclusion There is significant improvement in operative time for robotic assisted tubal anastomosis over time. The operative time of robotic assisted tubal anastomosis beyond the learning curve compares favorably, and may even surpass that of the laparoscopic approach, in our experience. Additionally, this is a cost-effective procedure in our institution when compared to laparoscopic approach.

Robotic-assisted laparoscopic tubal anastomosis: Single institution analysis.

Tubal anastomosis has similar pregnancy rates regardless of approach. Historically, robotic anastomosis has been associated with increased cost and operative time. We sought to perform a contemporary study of these metrics. One hundred and nine patients were identified who underwent robotic-assisted laparoscopic tubal anastomosis. Retrospective analysis of medical records was performed. Phone survey was conducted. The mean operative time decreased from 140.7 ± 27.0 min in 2013 to 60.0 ± 9.1 min in 2018, with significant downward trend (p < 0.001). The mean cost was $7153.46 ± $1484.41. The pregnancy rate was 59% (35/59), and tubal patency rate was 81% (42/52). Seventy-two percent of patients under 37 years became pregnant. There is significant improvement in operative time of robotic-assisted tubal anastomosis with surgical experience. Robotic tubal anastomosis outperformed historical metrics of laparoscopy and laparotomy with regard to operative time and cost in this series.

Analysis of pregnancy outcome after anastomosis of oviduct and its influencing factors

BackgroundThis study aims to investigate the influencing factors of pregnancy after laparoscopic oviduct anastomosis.MethodsThe data of 156 cases of laparoscopic oviduct anastomosis in our hospital were analyzed.ResultsThe pregnancy rate decreased with age (P < 0.005). The pregnancy rate after six years of anastomosis was higher in those with ligation (P < 0.005). The postoperative pregnancy rate significantly increased in subjects with oviduct lengths of > 7 cm (P < 0.01). The pregnancy rate of isthmus end-to-end anastomosis was higher (P < 0.005). The pregnancy rate after bilateral tubal recanalization was higher than that after unilateral tubal recanalization (P < 0.005). The pregnancy rate after laparoscopic tubal ligation and laparoscopic anastomosis was higher than that of open tubal ligation and laparoscopic anastomosis (P < 0.005).ConclusionThe pregnancy rate after laparoscopic oviduct anastomosis is higher in subjects below 35 years old, with a ligation duration of < 6 years, and a length of oviduct of > 7 cm, and those who underwent isthmus anastomosis and laparoscopic oviduct ligation and recanalization.

Reconstructive Tubal Surgery as an Alternative to Assisted Reproductive Technology After Tubal Sterilization: Experience in a Secondary Belgian Care Center

Abstract Objective: The goal of this research was to evaluate fertility outcomes after laparoscopic tubal anastomosis for reversal of tubal sterilization, and assess this procedure's place as an al...

Robotic-assisted tubal anastomosis with one-stitch technique.

The da Vinci® robotic surgical system has been used more often in recent years for tubal anastomosis (TA) and has been reported to have an increased operative time. A one-stitch technique has been used for the reanastomosis step in laparoscopic TA. To date, publications on robotically-assisted TA (RATA) describe an anastomotic step with multiple (usually four) sutures placed. This retrospective case series reports tubal patency data on patients who underwent RATA with the one-stitch technique; tubal patency was the outcome measure. Eighteen women (ages 27–39) underwent RATA with the one-stitch anastomotic technique in tertiary care medical centers between February 2009 and May 2012. Tubal patency was demonstrated in 16/17 patients (94.1 %), as evidenced by postoperative hysterosalpingogram (HSG) and/or subsequent pregnancies. We report the first case series which shows that RATA with a single stitch for the reanastomotic step is effective in achieving tubal patency as evidenced by postoperative HSG and/or pregnancies.

Laparoscopic Tubal Anastomosis. An Assessment of the “One-Stitch Technique”

The aim of the present study was to evaluate fertility outcome after laparoscopic microsurgical tubal anastomosis (one-stitch technique). We carried out a retrospective study of 51 patients seeking reversal of previous tubal sterilization. The mean age of the patients was 33.2 years (range: 30-44.5 years). Surgery lasted 122 minutes on average, (60-204 minutes). Mean time to pregnancy was 8.2 months (4-32 months) and the rate of pregnancy obtained was 56.2%. Twenty seven patients became pregnant and 12 had ectopic pregnancies; of the 15 intrauterine pregnancies, 3 miscarried spontaneously before 9 weeks. Our study observed valuable qualities of feasibility, simplicity and rapidity of the “one-stitch technique” in laparoscopic tubal anastomosis surgery, with related good rates of intrauterine pregnancy. The rate of pregnancy obtained is fairly similar to the rates reported in the literature with the same technique. However, the high proportion of ectopic pregnancies makes us believing that laparoscopic procedures using more than one single stitch should be preferred.

Fertility outcome analysis after modified laparoscopic microsurgical tubal anastomosis

Modified laparoscopic microsurgical tubal anastomosis is an alternative for microsurgical anastomosis via laparotomy to reverse sterilization in women with renewed child wish. The current study aims to evaluate the fertility outcome after modified laparoscopic microsurgical tubal anastomosis. A retrospective study was performed. Fifty-eight women who underwent modified laparoscopic microsurgical tubal anastomosis were monitored to investigate the fertility outcome and characteristics of this new technology. Of the 58 patients, the cumulative pregnancy rate (PR) in the 42 patients with follow-up data was 23.8% (10/42), 57.1% (24/42), 66.7% (28/42), and 73.8% (31/42) within 6, 12, 24, and 36 months after surgery, respectively. The intrauterine PR was 69.0% (29/42). Two patients (4.8%) had ectopic pregnancies that occurred within 24 months of surgery; three cases ended in spontaneous abortion. The delivery rate was 83.9% (26/31). The length of operating time was 1.2±0.3 h, with a range of 1.0-2.5 h (60-145 min), and the mean time was approximately 75 min. The blood loss was relatively small, between 10 and 50 ml with an average amount of 22 ml. Thus, the modified laparoscopic tubal anastomosis is a highly successful procedure and a viable alternative to open abdominal microsurgical approaches. Compared with the traditional laparoscopic tubal sterilization reversal, this modified approach has three advantages: (1) less invasive approach via a trocar reduction; (2) remodeling of tube is better performing tied together after 3-4 sutures; and (3) faster operating time.

Overcoming the Surgical Challenges of Laparoscopic Tubal Anastomosis

Overcoming the Surgical Challenges of Laparoscopic Tubal Anastomosis

Robotic tubal anastomosis: surgical technique and cost effectiveness

To evaluate the feasibility of robotic microsurgical tubal anastomosis and compare the results and cost effectiveness with the same procedure performed by laparotomy. Prospective cohort study. University hospital. Patients with a history of bilateral tubal ligation who desired reversal for future fertility. Tubal anastomoses through either a robotic approach or through a laparotomy. Operative times, hospitalization, complications, postoperative patency, clinical outcomes, and the cost per live birth. The mean operative time for robotic anastomoses was statistically significantly greater than open anastomoses (ROBOT 201 minutes; OPEN 155.3 minutes), although hospitalization times were statistically significantly shorter (ROBOT 4 hours; OPEN 34.7 hours). The return to instrumental activities of daily living was accelerated in the patients who had undergone a robotic anastomosis (ROBOT 11.1 days; OPEN 28.1 days). Although this was a small series, the pregnancy rates were comparable between groups (ROBOT 62.5%; OPEN 50%), yet the rate of abnormal pregnancy was higher in the robotic group (ectopic: ROBOT 4, OPEN 1; spontaneous pregnancy loss: ROBOT 2, OPEN 1). The cost per delivery was similar between the groups (ROBOT $92,488.00, OPEN $92,205.90). Robotically assisted laparoscopic microsurgical tubal anastomosis is feasible and cost effective with results that are comparable with the traditional open approach.

Laparoscopic Tubal Reanastomosis Using Robotics: Experience from a Teaching Institution

Tubal reanastomosis typically requires a laparotomy and in the past few years has been performed much less frequently due to the development and success of in vitro fertilization. Laparoscopic tubal anastomosis eliminates the need for laparotomy and can be performed in an out-patient setting. From October 2003 to September 2004, five patients who had previous tubal sterilization and requested tubal reanastomosis underwent laparoscopic tubal reanastomosis with the use of the da Vinci surgical system (Intuitive Surgical, Mountain View, CA). Ten fallopian tubes were successfully reconstructed, as confirmed by chromopertubation at the end of the procedure. Patency was confirmed by hysterosalpingogram in seven out of eight tubes. The mean (+/- standard deviation) time of the procedure was 172 +/- 53 min. The mean time for docking the robotic arms to the patient was 62 +/- 16.8 min and the mean robotic time was 97 +/- 36 min. There were two live births, one ectopic pregnancy, and one biochemical pregnancy. The mean time to conception was 5.5 +/- 2 months. Laparoscopic microsurgical tubal reanastomosis after tubal sterilization can be performed using a remote-controlled robotic system. Systematization of the operative steps allowed for operative times that compare favorably with the time needed for open microsurgical techniques. Larger series are needed to standardize the procedure and confirm postoperative fecundity rates.

REANASTOMOSIS TUBÁRICA POR VÍA LAPAROSCÓPICA

SUMMARY Background: Tubal ligation is used in a large number of young patients, who frequently want a new pregnancy, the percentage rate ranges from 1.3 to 15%. Until now the standard treatment has been the microsurgical tubal anastomosis through laparotomy, however, the development of new techniques and instruments allowed a laparoscopic approach for this surgery. Objectives: to make a synthesis of the hystory and operatory technics in laparoscopic tubal anastomosis to evaluate the inclusions criteria, the preoperative work-up, the factors of prognosis and to make a comparison between laparotomy and laparoscopy. Methods: We make a search in medline database (PubMed), with the key words: tubal anastomosis, reversal of sterilization, infertility, microsurgery, tubal sterilization, and selecting all of the review publications in microsurgical tubal reanastomosis by laparotomy and all of publications of the laparoscopic technic. Results: The microsurgical tubal anastomosis through laparotomy has a pregnancy rate ranging from 70% to 80%. The first publications whith the laparoscopic technic show dissapointed results, however, papers with bigger casuistics and with the microlaparoscopic technic show the same results that the open technic with all of the advantages of the laparoscopy. Conclusion: Laparoscopic tubal

Laparoscopic tubal anastomosis

Objectives: To evaluate the pregnancy outcome after laparoscopic tubal anastomosis. Methods: From December 1998 to December 2001, 26 patients with bilateral tubal ligation who underwent laparoscopic tubal anastomosis were prospectively evaluated. Patients’ age varied from 28 to 37 years. Results: Laparoscopic tubal reversal was performed in 23 patients. Bilateral reversal was possible in all but two patients. The operation time ranged from 95 to 155 min and all patients were discharged in the following morning after surgery. After 3 months, tubal patency was confirmed in 15 patients (15/23). Pregnancy rate was 56.5% (13/23), without ectopic pregnancies. The average time from tubal reversal and pregnancy was 6 months. Conclusions: In selected cases, laparoscopic tubal reversal can be offered to patients who had been submitted to tubal sterilization and desire new pregnancies. Patient selection as well as meticulous surgical technique are key factors in achieving satisfactory pregnancy rates.

Laparoscopic microsurgical tubal anastomosis with and without robotic assistance.

We previously reported our results with laparoscopic microsurgical tubal anastomosis with robotic assistance. The purpose of this study was to compare the duration of the procedure and hospitalization, blood loss and clinical outcomes for laparoscopic microsurgical tubal anastomosis performed with and without robotic assistance. This was a retrospective comparative case study in an academic tertiary referral centre. Laparoscopic microsurgical tubal anastomosis was performed on 10 women with robotic assistance and the subsequent 15 patients underwent the procedure without the robot. The length of the procedure, estimated blood loss (EBL), time until hospital discharge, tubal patency and clinical pregnancy rates were compared. The operative times were 2 h longer with robotic assistance (P < 0.001). The increased EBL with the use of the robot (70 +/- 68 ml versus 20 +/- 16 ml) was statistically but not clinically significant. The robot provided no benefit in patient recovery. Tubal patency and clinical pregnancy rates were not significantly different. Robotic assistance increases operative times of laparoscopic tubal anastomosis without an appreciable improvement in patient recovery or clinical outcomes.

Cost Analysis of Tubal Anastomosis by Laparoscopy and by Laparotomy

Study ObjectiveTo compare the costs of tubal anastomosis performed by laparoscopy and by laparotomy. DesignCost analysis study using the hospital administrative database (Canadian Task Force classification II-2). SettingUniversity teaching hospital. PatientsEighty-nine women. InterventionTubal anastomosis by laparoscopy (43) and by laparotomy (46). Measurements and Main ResultsTubal anastomosis took longer when performed by laparoscopy than by laparotomy; however, the total time patients spent in the operating room was similar. Women treated by laparoscopy spent more time in the recovery room. Labor costs for nurses in the operating room and recovery room costs were significantly higher in the laparoscopy group. Costs for operating room supplies were similar. Pharmacy costs and expenses in the ward were lower in the laparoscopy group. The mean total cost for laparoscopic tubal anastomosis was $861 ± 137 and for laparotomy was $1348 ± 188 (p <0.001). ConclusionLaparoscopic tubal anastomosis costs less than tubal anastomosis by laparotomy.

Fertility Outcome after Tubal Anastomosis by Laparoscopy and Laparotomy

Study Objective To evaluate fertility outcome and benefit of laparoscopic tubal anastomosis compared with laparotomy Design Retrospective study (Canadian Task Force classification II-2). Setting University hospital. Patients Eighty-one women requesting reversal of sterilization. Fertility outcome was analyzed in 76 patients for a minimum of 6 months. Intervention Laparoscopic tubal anastomosis in 37 women and abdominal tubal anastomosis in 44. Measurements and Main Results In both groups anastomosis was performed in two layers with four stitches using microsurgical technique. Overall pregnancy rates were 80.5% in the laparoscopy and 80.0% in the laparotomy group. The mean interval from operation to pregnancy was similar in the two groups (p = 0.9). Mean operating time was significantly longer for laparoscopy (201.9 ± 33.8 min) than for laparotomy (148.7 ± 32.5 min), including diagnostic laparoscopy. However, mean hospital stay was shorter for laparoscopy than for laparotomy (3.3 ± 2.0 vs 6.1 ± 0.6 days, p <0.05). Conclusion Laparoscopic tubal anastomosis is less invasive and could be an alternative to laparotomy for reversal of tubal sterilization. Advanced laparoscopic equipment and much experience could enhance the pregnancy rate and reduce operating time.

ROBOTIC ASSISTED, LAPAROSCOPIC PELVIC LYMPH NODE DISSECTION IN HUMANS

We evaluate the feasibility and efficacy of robotic assisted, laparoscopic pelvic lymph node dissection for locally advanced prostate cancer staging. Robotic assisted, laparoscopic pelvic lymph node dissection was performed in 10 consecutive patients with mainly T3 M0 prostatic carcinoma (robotic group). Operative, postoperative and pathological parameters were compared with the results of the last 10 patients undergoing conventional, laparoscopic pelvic lymph node dissection performed with similar indications by the same operator (laparoscopy group). All operations were performed according to the established protocol with no specific intraoperative or postoperative complications. No conversion was required, and no technical incidents were observed in the robotic group. Mean operating time plus or minus standard deviation for the robotic group was 125 +/- 57 minutes (range 75 to 215), significantly longer than that for the laparoscopy group, which was 60 +/- 15 minutes (p = 0.0013). In the robotic group 2 patients presented with postoperative lymphoceles revealed in 1 by deep venous thrombosis and in the second by obturator pain. In the laparoscopy group 1 patient presented with acute urinary retention. The histological results concerning the number of lymph nodes removed were similar in both groups (p = 0.5). We show the technical feasibility of robotic assisted, laparoscopic pelvic lymph node dissection in humans. Although the benefit of this technique has not yet been established, predictable technological improvements would suggest the development of telesurgery and an improved precision of surgical procedure.

Robotically assisted laparoscopic microsurgical tubal reanastomosis: a feasibility study

Objective: To assess the feasibility and reproducibility of laparoscopic microsurgical tubal anastomosis using a remote-controlled robot. Design: Descriptive case study. Setting: Academic medical center. Patient(s): Eight patients with previous laparoscopic tubal sterilization who requested tubal reanastomosis. Intervention(s): Systematization of the operative steps for laparoscopic tubal reanastomosis using a remote-controlled robot. Main Outcome Measure(s): Primary outcome measures were feasibility and reproducibility; secondary measures were tubal patency, operative time, complications, and ergonomic qualities. Result(s): The 16 tubes were successfully reanastomosed and patency was confirmed. The mean time that the robotic system was in use was 140 minutes, and mean surgical time was 52 minutes per tube. Conclusion(s): Laparoscopic microsurgical tubal reanastomosis after tubal sterilization can be performed using a remote-controlled robotic system. The robot, which has three-dimensional vision, allows the surgeon to perform ultraprecise manipulations with intraabdominal articulated instruments while providing the necessary degrees of freedom. Systematization of the operative steps allowed performance of the operation at a speed that compares favorably with the time needed for open microsurgical techniques. Larger series are needed to assess postoperative pregnancy rates.