Laparoscopic Tubal Reanastomosis Research Articles

Robotic Assisted Tubal Reanastomosis

<h3>Study Objective</h3> Indications for tubal reanastomosis include reversal of sterilization, midtubal block secondary to pathology, tubal occlusion from ectopic pregnancy, and salpingitis isthmica nodosa. The goal is to remove abnormal tissue and reapproximate the healthy tubal segments with as little adhesion formation as possible. <h3>Design</h3> This video demonstrates effective and efficient tubal reanastomosis technique using microsuturing on a robotic surgical platform. <h3>Setting</h3> Community hospital. <h3>Patients or Participants</h3> 35-yo G3P3 with prior tubal sterilization via Filshie clips, desires sterilization reversal, opposed to <i>in vitro</i> fertilization. <h3>Interventions</h3> Tubal reanastomosis utilizing the robotic surgical platform. <h3>Measurements and Main Results</h3> Successful bilateral tubal reanastomosis with resulting intrauterine pregnancy. <h3>Conclusion</h3> Laparoscopic tubal reanastomosis has been shown to boast equal pregnancy success rates as minilaparotomy, but is difficult to perform. Benefits of robotic assist include 3D visualization, tremor filtration, motion downscaling, wristed instrumentation, and micro instrumentation.

The feasibility of reduced sutures in 3D laparoscopic tubal sterilization reversal

Study ObjectiveTo show the technique of reduced sutures in 3D laparoscopic tubal reanastomosis. DesignStep-by-step demonstration of the procedure using video. SettingLaparoscopic tubal sterilization reversal demands high precision and requires both skill and experience. Conventionally, 4 to 6 interrupted patterns using 6-0 to 8-0 absorbable sutures are used for laparoscopic tubal reanastomosis. We used fewer and larger sutures under a magnified 3D view to perform the procedure. InterventionsWe presented a case of a 42-year-old woman, gravida 3, para 3, who underwent tubal sterilization during Cesarean section 10 years ago. Preoperative hysterosalpingography (HSG) showed bilateral distal tubal occlusion. The procedure started with the subserosal injection of diluted vasopressin in both proximal and distal ends and in the mesosalpinx to facilitate dissection and hemostasis. After transection of tubal stump and removal of scar tissue, we used a 3 Fr ureteral catheter as the stent to facilitate suturing. Three interrupted 4-0 monocryl sutures were used for suturing both tubal mucosal and muscular layers at 6, 2, and 10 o'clock sites. We performed bilateral ampullo-ampullary reanastomosis. The tubes were successfully reanastomosed, and patency was confirmed by chromotubation performed at the end of the procedure (Figure 1). The operation lasted for 71 minutes. The operative blood loss was less than 50 ml. Patent right fallopian tube was confirmed on postoperative HSG 1 month later. The patient had a successful pregnancy 8 months after the operation. ConclusionOur experience shows the feasibility of 3D laparoscopy for tubal reanastomosis using reduced sutures. The technique alleviates the damage to the fallopian tube. The operative time, hospital stay, and postoperative adhesions were significantly lower than the conventional method with a comparable success rate.

Laparoscopic Tubal Reanastamosis

<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.

Conventional Laparoscopy Is the Better Option for Tubal Sterilization Reversal: A Closer Look at Tubal Reanastomosis.

Background: Permanent sterilization is one of the most common methods of birth control in the United States and around the world. A small subset of women will regret their decision and desire future fertility. For these women, the options include in vitro fertilization (IVF) or surgical reversal. Surgical reversal, specifically via tubal reanastamosis, is an important choice to consider. Surgical reversal can be accomplished via three different general approaches including laparotomy, conventional laparoscopy, and robot-assisted approaches. Unfortunately, surgical reversal is becoming a lost art.Objective: To compare and contrast pregnancy success rates, ectopic pregnancy rates, and cost between the surgical methods and IVF.Methods: We conducted a literature review via Pubmed with keywords as listed below.Conclusion: Laparoscopic tubal reanastomosis is the best approach for women <40 years of age due to pregnancy outcomes that are comparable to other methods, cost effectiveness, and favorable safety profile of minimally invasive surgery.

Laparoscopic Tubal Re-anastomosis or In Vitro Fertilisation in Previously Ligated Patients: A Comparison of Fertility Outcomes and Survey of Patient Attitudes

We aim to compare live birth rates, cost analysis and a survey of patient attitudes between laparosopic tubal re-anastomosis and in vitro fertilisation (IVF). A retrospective study was done in a single reproductive medicine and IVF unit in Singapore from January 2011 to December 2016. Previously ligated patients underwent either laparoscopic tubal re-anastomosis or IVF. The primary outcome was first live birth after treatment. Interval to first pregnancy, miscarriage and ectopic pregnancies were also reported. Patients attending the subfertility clinic completed a questionnaire on IVF and tubal re-anastomosis on preferred choice of treatment, before and after reading an information sheet. Twelve patients underwent tubal re-anastomosis while 31 patients underwent IVF treatment. Pregnancy (75.0% vs 35.5%) and live birth (58.3% vs 25.8%) were significantly higher in the tubal surgery group (P <0.05%) after transferring all available embryos in one stimulated IVF cycle. Cost per live birth was lower in the tubal surgery group (SGD27,109 vs SGD52,438). One hundred patients participated in the survey. A majority of patients preferred tubal surgery to IVF (68.2% vs 31.8%) before given information on the procedures, but indicated a preference for IVF (54.6%) to surgery (45.4%) after receiving information on the procedures. For women less than 40 years of age, desiring fertility after tubal ligation, laparoscopic tubal re-anastomosis offers better live birth rates and cost-effectiveness. Patients in Singapore are equivocal as to their preference after education regarding the choices. Thus, laparoscopic tubal re-anastomosis remains a viable alternative to IVF treatment.

Laparoscopic Tubal Reanastomosis Outcomes - Case Reports.

Encountered between methods of contraception, tubal sterilization is not a priority in Romania. Moreover, many women regret their decision a few years later. The aim of this study is to present the reproductive outcome reported in Filantropia Clinical Hospital after laparoscopic tubal reanastomosis. Here we present two cases which underwent laparoscopic reversal. The first case opted for reversal tubal lgation after seven years from her single cesarean section. Despite the unilateral recanalization achieved, the woman onceived after only six months,. The second case was more challenging, taking into consideration the patient's medical history. Despite both tubes being permeable at the end of the procedure, the patient did not conceive at the time being. Our experience confirms that laparoscopic tubal reanastomosis is also available in tertiary centers in Romania and could be a safe method for women who seek reversal, shortly after tubal sterilization. The success rate is unknown due to the limited number of cases. Therefore, further research is required.

Pregnancy outcome of laparoscopic tubal reanastomosis: retrospective results from a single clinical centre.

ObjectiveTubal sterilization is a widespread method of contraception. Post-sterilization regret is encountered, despite careful consideration prior to the procedure. Two treatment options are available for women after having had tubal sterilization: microsurgical reversal and IVF treatment. Recent improvements in laparoscopy have allowed tubal reanastomosis to be performed. This study aimed to evaluate the reproductive outcome after laparoscopic tubal reanastomosis and surgical features of the patients.MethodsFrom June 2007 to January 2010, 27 patients with bilateral tubal ligation who underwent laparoscopic tubal reanastomosis were evaluated retrospectively. Tubal sterilization was performed by Pomeroy’s technique during caesarean section in all of the patients. Before surgery, all of the patients were evaluated for possible other causes of infertility and the results of the evaluation were normal.ResultsThe mean age of the patients was 31.8 years (range, 27–38 years). The mean interval between sterilization and reversal was 5.1 years (range, 1–14 years). Bilateral reversal was achieved in 24 patients. The operation time ranged from 85 to 140 minutes with a mean time of 105 minutes. All of the patients were discharged on the next day. There were no postoperative complications. Overall pregnancy, intrauterine pregnancy, and ectopic pregnancy rates were 55.5% (15/27), 51.8% (14/27), and 3.7% (1/27), respectively. Of the 14 intrauterine pregnancies, one ended with abortion at 6 weeks’ gestation (1/14). The mean interval from surgery to pregnancy was 270 days (range, 147–420 days).ConclusionLaparoscopic tubal reanastomosis has the advantages of fewer complications, less postoperative discomfort, a smaller incisional scar, a shorter recovery time, and earlier resumption of normal activities. This technique has a satisfactory pregnancy rate in selected patients who desire reversal of tubal sterilization.

Laparoscopic Tubal Reanastomosis Using Barbed Sutures

Study ObjectiveTo show a new technique of laparoscopic tubal reanastomosis using barbed sutures. DesignStep-by-step explanation of the technique using videos. SettingLaparoscopic tubal reanastomosis is an effective procedure with a high success rate for reversal of tubal sterilization. Conventionally, 4 equidistant interrupted sutures are placed under a magnified view for laparoscopic tubal reanastomosis. This step demands high precision and requires a lot of skill and experience. We have tried to simplify this suturing technique by using barbed sutures because they do not require knotting. Two separate 5-0 Quill barbed sutures (Angiotech Puerto Rico Inc, Aguadilla, Puerto Rico) are used in this technique. The first suture is used for taking 6 and 3 o' clock stitches. The second suture is used for taking 9 and 12 o' clock stitches. With this technique, the purse-string effect on the tubal lumen is reduced. InterventionsLaparoscopic tubal reanastomosis using 5-0 Quill barbed sutures (equivalent to United States Pharmacopeia suture size 6-0). ConclusionThis technique of laparoscopic tubal reanastomosis using barbed sutures is a feasible and simpler alternative to conventional suturing.

Should we use visual entry techniques in patients with previous laparotomies?

Laparoscopic surgery has become the method of choice for treating an ever increasing number of gynaecological disorders that require surgery. However, primary port insertion is a potentially dangerous step especially in patients with previous laparotomies. The aim of this study is to identify whether visual entry technique has any advantage over the closed one in patients with previous laparotomies. This is a retrospective observational case control study of 2541 patients with previous laparotomies who underwent laparoscopic surgery from January 1992 to September 2003 at Vijaya Hospital, Kochi and from October 2003 to October 2015 at Department of Endoscopy, Paul’s Hospital, Kochi, India. The control group comprised of 1261 patients, operated between January 1992 and September 2003 at Vijaya Hospital, Kochi, in whom closed technique of abdominal access for primary port creation was used. The study group comprised of 1280 patients, operated between October 2003 and October 2015 at Department of Endoscopy, Paul’s Hospital, Kochi, in whom visual entry (EndoTIP) was used for primary port creation. Procedures included in both groups were total laparoscopic hysterectomy, laparoscopic myomectomy, laparoscopic ovarian cystectomy, laparoscopic conservative surgery, laparoscopic tubal reanastomosis, laparoscopic sacrocolpopexy, laparoscopic sacrocervicopexy, laparoscopic adhesiolysis and laparoscopic sterilisation. There was no evidence of intestinal or vascular injury during visual entry using a blunt EndoTIP cannula. There were three cases of bowel injury with the closed, blind entry technique using a sharp linear trocar in the control group. The p value (Chi-square test) is 0.04, which is statistically significant. Visual entry, as an approach to abdominal access in patients with previous laparotomies, wherein chances of encountering peritoneal and bowel adhesions are very high, is safer than the closed blind entry technique in preventing bowel injuries.

Laparoskopik Tubal Reanastomoz Sonrası İlk Ovulasyonla Oluşan Sürpriz Gebelik

Laparoskopik Tubal Reanastomoz Sonrası İlk Ovulasyonla Oluşan Sürpriz Gebelik

Laparoscopic non-microsurgical tubal reanastomosis: A retrospective cohort study

Objective To determine the pregnancy rate achieved through laparoscopic tubal reanastomosis using only standard 5 mm laparoscopic instruments and standard suturing material.Methods Data from 100 consecutive laparoscopic tubal reanastomosis procedures done between September 2002 and September 2010 were retrospectively analysed. All procedures were performed by the same surgeon using standard 5 mm laparoscopic instruments and with the placing of three or four sutures of standard polyglycan 4/0 suturing material. The main outcome measures were: (intrauterine) pregnancy rate and live birth rate before and after 40 years of age, and tubal patency rate.Results Six patients had no active child wish and six others were lost to follow-up, thus leaving 88 of 100 patients for evaluation. Fifty-eight of these conceived, giving a total pregnancy rate (PR) of 66%. The PR in women younger than 40 years was significantly greater than that achieved by those aged 40 or more (73% vs. 29%, p = 0.001).Conclusions Laparoscopic tubal reanastomosis with standard 5 mm laparoscopic instruments results in a satisfactory pregnancy rate.Chinese 摘要：目的 测定那些仅采用标准5毫米腹腔镜的手术器械及标准缝合材料进行输卵管复通术的患者的受孕率。方法 本研究对2002年9月至2010年9月之间进行输卵管复通术的患者进行了回顾性的分析。所有患者均由相同的外科医师采用标准的5毫米腹腔镜手术器械，并且采用三至四个4/0标准多聚糖缝合线。主要结果评定:40岁左右患者(宫内)妊娠率和活产率,以及输卵管通畅程度。结果 在100位患者中，有6例患者没有妊娠的意愿,6位患者失访,因此我们对剩余的88位患者进行了评估。其中58位患者妊娠，总妊娠率为66%。40岁以下的年轻女性的受孕率明显高于那些40岁以上的女性（73%比29%，P<0.001）结论 采用5毫米标准腹腔镜手术器械进行的腹腔镜下输卵管复通术可以取得满意的妊娠效果。

Laparoscopic tubal reanastomosis versus in vitro fertilization: cost-based decision analysis

Regret after tubal ligation continues to be a problem. After tubal ligation, couples have the option of tubal surgery or in vitro fertilization (IVF). Using decision analysis techniques, we compared cost-effectiveness of tubal reanastomosis by tubal type vs tubal surgery or invitro fertilization (IVF) for 3 separate age groups of women: <35 years of age, 35 to 40 years of age and >40 years of age. Tubal techniques was divided into type A, those with more favorable prognosis because of the likelihood of having a more significant length tube at time of reanastomosis and type B, those with a worse prognosis of success. We incorporated delivery costs to address the impact of high order multiples in IVF. Data were extracted by studies available in the literature. All costs were adjusted to 2012 US dollars. One-way and 2-way sensitivity analyses were performed. The laparoscopic reanastomosis of type A dominated the other groups, because it was more effective and less costly then type B and IVF. However, when women were >40 years old with a history of type B, IVF was favored when its costs were at the lower limit. The most cost-effective choice for a woman desiring pregnancy after tubal ligation is laparoscopic reanastomosis after a prior clip or ring tubal ligation for women ≤40 years old. It is also the most cost-effective for the oldest cohort, assuming IVF costs are greater than $4500.

Laparoscopic tubal reanastomosis versus in vitro fertilization: cost- based decision analysis incorporating multiple patient ages, ligation technique and impact of multiple gestation

Regret after tubal ligation continues to be a problem. After tubal ligation couples have the option of surgical tubal reanastomosis (TRA) or assisted reproductive techniques with in vitro fertilization (IVF).

Pregnancy outcomes and prognostic factors from tubal sterilization reversal by sutureless laparoscopical re-anastomosis: a retrospective cohort study

Female sterilization is a widely used contraceptive method but in a small group of women, post-sterilization regret occurs. A dilemma for these women is the choice between surgical re-anastomosis and IVF. We evaluated the factors that affected pregnancy rate after laparoscopic tubal re-anastomosis for sterilization regret. We included women who underwent a laparoscopic tubal re-anastomosis between January 1997 and March 2008 at Máxima Medical Centre, The Netherlands, in a retrospective cohort study. Microsurgical laparoscopic re-anastomosis was performed using a serosa-muscular fixation/biological glue technique. The primary outcome was time to clinical pregnancy (TTP). Other outcomes were ongoing pregnancy and ectopic pregnancy. We studied whether clinical characteristics, including age, fertility history, BMI, semen quality, remaining tubal length and type of anastomosis, could predict the chance of pregnancy. Data from 127 patients were analysed. The 40-month cumulative clinical pregnancy rate was 74%, whereas the ongoing pregnancy rate was 59%. There were five ectopic pregnancies (3.9%). Only age was found to influence the probability of a positive pregnancy test, hazard rate ratio (HRR): 0.32 [95% confidence interval (CI) 0.12-0.88] and ongoing pregnancy [HRR 0.21 (95% CI 0.05-0.87)]. Previous pregnancy increased pregnancy probability [HRR: 2.2 (95% CI 0.51-9.8)]. A total sperm motility count of <20 million was related to prolonged TTP. Sutureless laparoscopic tubal re-anastomosis is an effective treatment for women who regret sterilization. Age, previous pregnancies and sperm quality should be considered when counselling for tubal sterilization reversal versus IVF. A randomized prospective trial comparing success rates of surgical reversal and IVF after sterilization regret should be conducted.

Robotically assisted laparoscopic microsurgical tubal reanastomosis: a retrospective study

To evaluate the pregnancy and delivery outcome of robot-assisted tubal reanastomosis. Retrospective cohort study. University hospital. Ninety-seven patients with available follow-up who underwent the reversal of tubal ligation, with a median age of 37 years (range, 24-47 years). Tubal reanastomosis by robot-assisted laparoscopy. Analysis of the distribution of time to conception and to estimate the crude pregnancy and birth rates at 2 years. The overall pregnancy and birth rates were 71%, (95% confidence interval [CI], 61%-80%) and 62% (95% CI, 52%-72%). Ninety-one percent (95% CI, 76%-98%) of patients <35 years old became pregnant, and 88% (95% CI, 72%-97%) delivered at least once. The corresponding pregnancy and delivery rates were 75% (95% CI, 57%-89%) and 66% (95% CI, 47%-81%) between 36 and 39 years old, 50% (95% CI, 25%-75%) and 43.8% (95% CI, 20%-70%) between 40 and 42 years old, 33% (95% CI, 10%-65%) and 8.3% (95% CI, <1%-38%) after the age of 43 years. This study reports satisfactory birth rates after tubal reanastomosis by robot-assisted laparoscopy inpatients aged 40 years or less.

Laparoscopic microsurgical tubal re-anastomosis: the two-stitch technique

The objective of this study was to determine the effectiveness of the two-stitch unilateral laparoscopic sterilization reversal. Thirty-three patients who had undergone unilateral laparoscopic sterilization reversal between December 2001 and October 2006 were examined. Twenty patients (60.6%) who had had laparoscopic unilateral tubal sterilization reversal achieved an ongoing pregnancy within 1 year of the operation. In vitro fertilization (IVF) was recommended to the other 13 patients, including one patient (3%) who had an ectopic pregnancy. In conclusion, in our study, the pregnancy rate after unilateral two-stitch laparoscopic tubal reversal was 60.6%. In this IVF era, tubal anastomosis will become more popular, causing fewer women to resort to IVF and experience a completely natural conception, making surgery complementary to ART. The number of surgeons skilled in laparoscopic tubal surgery must, therefore, be increased.

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.

Laparoscopic microsurgical tubal reanastomosis: a preliminary study.

To determine the effect of laparoscopic reversal of tubal sterilization on pregnancy rate. Eight patients who underwent laparoscopic tubal reversal between March 1999 and 31 December 2001 were evaluated. Four of eight patients who had had laparoscopic tubal reversal became pregnant. Three have delivered; pregnancy in the fourth woman is ongoing. To date, the other four patients are still not pregnant. Two ofthese four cases have tubal patency but have not achieved pregnancy; in the other two cases, the operation was unsuccessful and tubal patency did not occur. In our preliminary study, the pregnancy rate was 50%.

Fertility outcomes following laparoscopic tubal re-anastomosis post tubal sterilisation.

To determine fertility outcomes following laparoscopic tubal re-anastomosis. Retrospective mail follow-up. Specialised private gynaecological endoscopy practice. 19 women who underwent laparoscopic tubal reanastomosis following tubal sterilisation. Pregnancy rate and 'take home baby' rate. 15 (78.9%) of women became pregnant, and 13 (68.4%) carried pregnancies to viability. The mean operating time was 115 minutes (range 90-200 minutes). The mean reversal to pregnancy interval was 8.3 months (1-24 months). This study suggests that the pregnancy and 'take home baby' rates after laparoscopic reversal of tubal sterilisation compare favourably with open microsurgical reversal and in vitro fertilisation.

Laparoscopic microsurgical anastomosis of the blocked, solitary post-ectopic Fallopian tube: Case report

The surgical options for the management of ectopic pregnancy include linear salpingotomy or salpingectomy. If salpingotomy is performed, subsequent tubal blockage may result and if this occurs in a solitary Fallopian tube then assisted reproductive technology is recommended as the treatment of choice. We describe a case report detailing the application of laparoscopic microsurgical tubal reanastomosis in two patients with post-ectopic blockage in a solitary Fallopian tube. Both patients conceived post-operatively and subsequently delivered term pregnancies. Laparoscopic microsurgery offers an alternative to assisted reproductive technology in patients with post-ectopic tubal obstruction in a single Fallopian tube.