Laparoscopic Tubal Anastomosis

A very popular method of birth control in the United States is tubal sterilization.

Over one million of these surgeries are performed annually. Many are done soon after delivery (post-partum) or during cesarean section. Others are done electively (interval tubal sterilization) either by laparoscopy or by mini-laparotomy. Tubes are either cut, burned, or both; rings (falope ring) or clips (hulka filshie) are applied to secure and permanently close the tubal lumen.

A significant number of these patients find themselves, later in life, wanting to conceive. Reasons include divorce, new marriage, loss of children, or simply the realization that they would like a larger family. Traditionally, tubal reconnection has been attempted through laparotomy (opening of the abdomen) and using microscopes or other image-enhancing devices. The recovery time after this type of operation could be several weeks.

Over the last few years, our team has developed and implemented new techniques and instrumentation that allow us to successfully perform these procedures laparoscopically in an outpatient setting. The lack of a large abdominal incision assures a much faster recovery and minimizes the immediate as well as the long-term complications. The success rate is expected to be better than the traditional method; however, it also depends on the patient’s age, type of ligation, and condition of the tubes at the time of the operation. Other fertility factors are evaluated and corrected as necessary.

Our team has a 79% pregnancy rate with laparoscopic tubal reversal in patients under age 35 where two tubes were successfully reconnected.

Results (pregnancy) vary depending on many factors, such as a patient's age, the type of ligation, location of the obstruction and presence or absence of other fertility factors. These numbers are revised frequently as we evaluate new cases. Each case is different depending on individual variations in the way your body heals or the tendency to develop scar tissue. In our hands, laparoscopic reversal has proved superior to the traditional method of open abdomen (laparotomy or mini-laparotomy) with better results and much faster recovery.

Click here for details about this procedure.

To view a short video of our advanced laparoscopic tubal reversal procedure, please click the image below. Please note that our video is being hosted by YouTube.com, and any links to outside content are beyond our control. Their presence on our site does not imply any endorsement on our part.

Laparoscopic Tubal Reversal Video

 

If you would like more information or an appointment, please contact us.

Details about Laparoscopic Tubal Reversal

Our technique of Laparoscopic Tubal Reversal is a minimally-invasive surgery, using small, specially-designed instruments to repair and reconnect the fallopian tubes.

Many of these instruments have been designed by our group to facilitate, improve, and spread the use of this technique.

After general anesthesia has been administered, we begin by inserting a 10mm (about 3/8-inch) tube just at the lower edge of the navel, and a special gas is pumped into the abdomen to create enough space to perform the operation safely and precisely.

The laparoscope (a telescope), attached to a camera, is brought into the abdomen through the same tube, and the pelvis and abdomen are thoroughly inspected. The tubes are evaluated and the obstruction (ligation, burn, ring, or clip) is examined.

Three small instruments (5mm each) are used to remove the occlusion and prepare the two segments of the tube to be reconnected.

A special instrument (tubal cannulator) is inserted into the uterus (womb) through the cervix, and the tube is threaded with a fine stent. This allows for improved alignment of the tubes, so a much better connection can be accomplished.

Tiny sutures (less than a hair in thickness) are carefully and meticulously placed to connect the two segments.

Once the connection (anastomosis) is completed, a blue dye is injected through the cervix, traveling through the uterus and tubes, all the way to the abdomen. This is to make sure the tubes have been aligned properly and that the connection is working well.

All instruments are removed, the air is extracted from the abdomen, and the patient is awakened and taken to the recovery room to be watched and cared for by the nurses, as well as by the anesthesiologist who makes sure the patient is comfortable and without pain.

On the average, two to four hours later most patients are ready to be discharged.

Patients are seen between 5-7 days after the operation to look at the small incisions and remove any stitches if necessary. Most of the time, the few stitches that were placed will be under the skin and will be absorbed by the body, without need for removal.

Patients should wait three months prior to attempting pregnancy in order to give the tubes a chance to heal completely. Trying to conceive before then could result in an increased risk of ectopic pregnancy (pregnancy inside the fallopian tube instead of in the uterus).

If you would like more information or an appointment, please contact us.