Microsurgical Tubal Anastomosis Research Articles

Correlation of prognostic factors and outcome of Microsurgical Tubal Recanalisation

Objective:1)To study the outcome of microsurgical tubal recanalisation. 2) To analyse the various factors affecting the pregnancy rate following microsurgical tubal recanalisation. Method: It is a retrospective clinical study conducted on 45 women who underwent microsurgical tubal recanalisation at Adichunchangiri institute of medical sciences from January 2006 to June 2013. Results: The overall pregnancy rate after microsurgical tubal anastomosis was 55.5% with 72% of live birth rate. Loss of only child was the main reason for requesting sterilisation reversal. Pregnancy rate was noted to be significantly more statistically in women aged 5cm and isthmo-isthmic type of anastomosis. Though the pregnancy rate was more 62.9% in women who underwent reversal after laparoscopic sterilisation when compared to Pomeroy’s method 44.4% there was no stastistical significance. Conclusion: Microsurgical reversal of tubal sterilisation is a good option for patients who want a child for various reasons after tubal sterilization and cannot afford IVF. Those with least amount of tubal destruction had better chances of pregnancy. Laparoscopic sterilisation should be preferred during sterilisation procedure, ligation should be done at isthmus and good length of tube preserved .

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.

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.

Reversal of tubal sterilization versus IVF in the era of assisted reproductive technology: a clinical dilemma

Two treatment options are available to women who wish to become pregnant after having had tubal sterilization: microsurgical reversal or IVF. The first approach is designed to restore tubal function, whereas the second replaces it. The first, to be successful, requires the presence of sufficient tubal length and normal or treatable fertility parameters. Treatment should therefore be individualized, based upon the findings of the couple's investigation, their wishes and the costs involved. The age of the female is the most important factor that affects the outcome with both treatment options. The live birth rate per cycle with IVF is 28%, but only 65.8% are singletons; 31.0% are twins and 3.2% triplets or more. Microsurgical tubal anastomosis yields a birth rate that exceeds 55%, without increased risk of multiple pregnancy. It offers the couple multiple cycles in which to achieve conception naturally, and the opportunity to have more than one pregnancy from a single intervention. The real dilemma lies with the ‘industrialization’ of IVF, and its frequent use as primary treatment for infertility. The dilemma is heightened by the fact that reconstructive tubal microsurgery is being taught and practised less and less, thereby eliminating this credible surgical option in most centres.

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

Erneuter Kinderwunsch nach Tubensterilisation

Purpose: A significant number of previously sterilized women desire the restoration of their fertility for various reasons, although the primary motive is a desire to conceive additional children in a new relationship. Microsurgical tubal anastomosis is one of the most promising techniques for reestablishing fertility. This paper evaluates the success rates of this procedure. Material: From 1990 to 2000, 110 women underwent microsurgical tubal anastomosis by mini-laparotomy. Data subsequently gathered from 76 of these patients was included in this retrospective analysis. The remaining 34 patients could no longer be contacted. Results: This study focused on the first pregnancy after the surgical procedure. 75% (57/76) of women became pregnant, including 5.3% ectopic pregnancies (4/76) and 15.8% miscarriages (11/75). The median age of these women was 34.44 years (26-42). 53.9% of the patients delivered healthy babies (41/76). 19 out of 76 patients (age 37.68 [31-42]) did not conceive (25%). In comparison, the pregnancy rate and birth rate of a single IVF-procedure in Germany 2001 (performed for tubal pathology) was reported as 26.65 and 15.98% respectively. Conclusion: The pregnancy rate of 75% and the birth rate of 53.9% after microsurgical tubal anastomosis are significantly higher compared to a single IVF procedure. However, using multiple in-vitro fertilizations can lead to higher success rates. The advantages of reestablishing fertility when compared with IVF are the permanent reestablishment of the ability to conceive with a single therapeutic intervention, generally higher rates of postoperative pregnancies and live births, the possibility of additional pregnancies without renewed therapy and generally overall lower costs. Microsurgical refertilization through mini-laparotomy should be recommended to women, including older women at the ages of 42 or 43, who have been previously sterilized and who desire renewed fertility after excluding serious ovarian or andrological diseases.

An unusual complication of tubal anastomosis

Objective To report an unusual complication associated with the use of a long-term intrafallopian stent during microsurgical tubal anastomosis. Design Case report. Setting Tertiary academic center. Patient(s) A 36-year-old woman in whom an intrafallopian stent used during a sterilization reversal procedure could not be transcervically retrieved in the office. Intervention(s) Hysteroscopic evaluation for removal of intrafallopian stent, followed by operative laparoscopy for postoperative abdominal pain. Main outcome measure(s) Patient symptoms, potential for morbidity, and review of the literature. Result(s) Hysteroscopic view of the uterine cavity failed to identify the intrafallopian stent. Laporoscopic evaluation of postoperative abdominal pain revealed significant formation of pelvic and abdominal adhesions. The 2-0 nylon suture used as an intrafallopian stent was seen sitting freely on top of the liver serosa. Adhesiolysis and successful retrieval of the stent resolved the patient’s symptoms. Conclusion(s) To our knowledge, this is the first report describing complete dislodgment and cephalad migration of an intrafallopian stent. Patient morbidity and health care costs may increase when long-term stents are used for sterilization reversal.

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.

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.

Laparoscopic microsurgery: current and future status.

The successful introduction of microsuturing and microinstruments for operative laparoscopy has allowed the convergence of laparoscopy and traditional microsurgery, resulting in the evolution of the 'new microsurgery'. This more dynamic approach overcomes the limitations of open microsurgery by providing continuous magnification and the benefits of a closed environment, making laparoscopy a complete surgical tool. The test model for microsurgery is tubal anastomosis, which is very dependent on operative technique to attain well-established pregnancy rates. Our cumulative pregnancy results for laparoscopic microsurgical tubal anastomosis of 76% at 12 months, 70% at 9 months, 67% at 6 months and 44% at 3 months, compares favorably to the best results achieved by traditional open microsurgery. With this validation the technique is now employed as a complete solution for all tubal surgery. The ability to effect microsurgical repair of the ureter, bladder, bowel and vessels has expanded the surgical repertoire, allowing radical excision of deep endometriosis, severe enterolysis, and adhesiolysis.

LAPAROSCOPIC MICROSURGICAL TUBAL ANASTOMOSIS

The authors explored the feasibility of performing true microsurgery through the laparoscope in 1990. The first laparoscopic microsurgical tubal anastomosis was performed in February 1992. Operative laparoscopy will continue to expand as technical feasibility continues to improve, driven by both hardware advances and increased surgical dexterity. Laparoscopic microsurgery will introduce a new dimension to reproductive surgery and over time, will replace laparotomy for microsurgery.

Single suture laparoscopic tubal re-anastomosis.

The goal of this article is to report our experience and review recent articles obtained for laparoscopic tubal sterilization reversal. The technique we describe is 'single suture laparoscopic tubal re-anastomosis'. This technique is simple and atraumatic and requires only one stitch in the tube. After preparing the tube stumps and bringing the edges of the mesosalpinx together, laparoscopic anastomosis is achieved by one stitch placed at '12 o'clock' on the antimesial edge of the tube. Between May 1994 and June 1997 we operated on 32 patients using this technique and carried out 48 tubal sterilization reversals. For the patients who underwent postoperative hysterosalpingography during the first or second month after the operation, the rate of patency was 87.5% (42/48). The overall intrauterine pregnancy rate was 53.1% (17 out of 32 patients). The overall delivery rate was 40.6% (13 out of 32 patients). The intrauterine pregnancy rate for the 17 patients who were aged 38 years or under was 58.8% (10 out of 17 patients). Laparoscopic tubal sterilization reversal is feasible with a simplified technique. Review of the publications concerning laparoscopic microsurgical tubal anastomosis confirms satisfactory fertility results. The surgeon should be experienced in microsurgical tubal anastomosis by laparotomy as well as operative laparoscopic procedures.

Microsurgical reversal of tubal sterilization: a report on 1,118 cases

Objective: To review and evaluate a series of patients who underwent microsurgical anastomosis of previously sterilized fallopian tubes. Design: Retrospective clinical study. Setting: Tertiary care academic center. Patient(s): In the 134–month span from January 1980 to February 1991, 1,118 women were evaluated for microsurgical reversal of previous tubal sterilization. Main Outcome Measure(s): Clinical characteristics of patients, pregnancy rates (PRs), and factors influencing the outcome. Result(s): Of 1,118 patients, 633 (56.6%) had been sterilized by laparoscopic cautery. Loss of children was a leading reason for requesting tubal reversal. The mean interval between tubal sterilization and reversal was 51.9 months. Nine hundred twenty-two (82.5%) patients were followed up for > 5 years. The overall PR after microsurgical tubal anastomosis was 54.8% (505 of 922) with a delivery rate of 72.5% (366 of 505), and the estimated anatomical success rate was 88.2% (814 of 922). There was no statistically significant difference in the PR or in the interval from tubal reversal to conception among the different operative procedure groups. In addition, no statistically significant difference in the PR was observed regardless of the postoperative tubal length. However, the interval from operation to pregnancy decreased significantly as the postoperative tubal length increased. The pregnant patients ( n = 505) were younger and had a longer postoperative tube than the nonpregnant patients ( n = 417); these differences were statistically significant. Conclusion(s): The pregnancy rate after microsurgical reversal of tubal sterilization was not significantly correlated with the method and duration of sterilization, the operative procedure, or the postoperative tubal length.

Surgical management of cornual-isthmic tubal obstruction

Objective: To examine the efficacy of microsurgical tubal anastomosis among patients having failed attempts to correct cornual-isthmic tubal obstruction by hysteroscopic tubal catheterization. Design: An open observational trial. Setting: A tertiary referral reproductive medicine practice. Patient(s): Forty-three patients with laparoscopically confirmed bilateral cornual-isthmic obstruction and otherwise normal fallopian tubes. Thirty-three control patients with a history of elective sterilization presenting for tubal anastomosis. Intervention(s): All patients with bilateral cornual-isthmic obstruction underwent attempted hysteroscopic tubal cannulation. Those unsuccessfully catheterized proceeded with microsurgical resection and anastomosis. Candidates for reversal of sterilization underwent microsurgical repair in standard layered technique. Main Outcome Measure(s): Mean time to achieve pregnancy, as well as cumulative pregnancy rates for all three groups using life-table analysis, were calculated. Result(s): Cumulative pregnancy rates for patients with successful tubal catheterization, for those requiring microsurgical repair, and for reversal of elective sterilization were 0.68%, 0.56%, and 0.29%, respectively, at 12 months. Mean duration to achieve pregnancy was similar for both cornual-isthmic blockage-treated groups and was shorter than that for the sterilization-reversal group. Conclusion(s): Patients with cornual-isthmic obstruction and otherwise normal fallopian tubes who are treated successfully by either tubal catheterization or resection and microsurgical anastomosis demonstrate high pregnancy rates, short interval to achieve pregnancy, and similar obstetric outcome. If no pregnancy is achieved within 1 year of surgery, reevaluation and consideration for possible IVF and ET is indicated.

Fertility outcome after laparoscopic microsurgical tubal anastomosis

To evaluate fertility outcome after laparoscopic microsurgical tubal anastomosis. A retrospective study. Infertility Medical Center affiliated with University Medical School. Fifty-four patients, who had previously undergone tubal sterilization, seeking reversal. Laparoscopic microsurgical tubal anastomosis was performed. Pregnancy success was assessed. The overall pregnancy rate (PR) was 77.5% (38/49) and 29 patients already have delivered healthy offspring. Pregnancy in seven patients is ongoing and one case ended in abortion. There was one case of ectopic pregnancy. The pregnancy success according to the method of previous tubal sterilization was 16 of 24 with the Fallope-ring method, 14 of 15 in cases of cauterization, and 8 of 10 in patients in whom the Pomeroy technique was used. The pregnancy success according to the site of anastomosis was 3 of 4 in cornual-isthmic, 4 of 5 in isthmic-isthmic, 26 of 35 in isthmic-ampulla, 3 of 3 in cornual-ampulla, and 2 of 2 in ampulla-ampulla. The pregnancy success according to the tubal length was 5 of 7 at a length < or = 4 cm, 3 of 5 at 5 cm, 15 of 17 at 6 cm, and 15 of 20 at lengths > or = 7 cm. Considering the high PR in our minimal follow-up period of 12 months, laparoscopic microsurgical tubal anastomosis could be an alternative procedure to microsurgical laparotomy in patients requesting reversal of tubal sterilization.

Reproductive outcome after tubal reversal in women 40 years of age or older

To determine the reproductive outcome of women who received a microsurgical tubal anastomosis operation at age 40 years or older. Multicenter retrospective cohort study. Four university teaching hospitals. Fifty-two women having undergone tubal sterilization reversal at age > or = 40 years. Pregnancy and live birth rate. Of the 52 women, 10 were lost to follow-up. Of those traced, 18 of 42 (42.8 percent) conceived. Of those 18, 6 patients had a live birth, 10 patients had a first trimester spontaneous abortion, 1 patient had an ectopic pregnancy, and 1 patient had an elective termination. Overall, the live birth rate was 14.3 percent, spontaneous abortion rate was 23.8 percent, and ectopic pregnancy rate was 2.4 percent. Microsurgical tubal anastomosis is a justifiable alternative to IVF-ET in women age 40 years or older.

Combined laparoscopy and minilaparotomy for outpatient reversal of tubal sterilization.

This retrospective study determines risks, outcomes, and cost savings in microscopic tubal sterilization reversal done by minilaparotomy. From January 1992 to December 1993, 40 women, as outpatients, had combined laparoscopy and minilaparotomy for tubal anastomosis. The mean operating time was 1.7 hours, mean blood loss was 20 mL, and mean recovery time was 3.2 hours. Thirty-seven patients (93%) were discharged on the same day, two stayed for 23 hours, and one patient required hospitalization for 2 nights. There were no immediate or postoperative complications. Early crude pregnancy rate was 60%, with an 8% ectopic rate. Tubal patency was confirmed in 39 (98%). The average total cost to the patient was $5,200. Microsurgical tubal anastomosis can be done safely and successfully on an outpatient basis, reducing costs and morbidity and accelerating the patient's return to activity.

Clinical experience with laparoscopic microsurgical tubal anastomosis

Clinical experience with laparoscopic microsurgical tubal anastomosis