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Laparoscopic tubal reversal for Fallopian tube ligation

Authors

A Wattiez, J Nassif, C Zacharopoulou, J Marescaux

Abstract

Tubal ligation is considered an irreversible method for contraception. After this intervention, some patients will ask to reverse this procedure. This video shows laparoscopic reversal for tubal ligation.

Keywords

tubal ligation, contraception, tubal reversal, laparoscopy

Media type

Duration

07'10''

Publication

2008-06

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E-publication

WeBSurg.com, Jun 2008;8(06).
URL: http://www.websurg.com/doi-vd01en2331.htm

Laparoscopic tubal reversal for Fallopian tube ligation

1. Exploration and testing proximal tubal patency 00'17''

After evaluating possible tubal reversal by examination of the proximal and distal part of the uterine tube, we cut the edge of the proximal part on the left side. We inject concentrated methylene blue in the uterine cavity to test the tubal patency. We do the same on the right side by inspecting the proximal and distal tubal parts and cutting the edge of the proximal part. We also test for tubal patency.

2. Testing distal tubal patency 01'06''

We also cut the edge of the distal side. Before beginning the anastomosis, we test the distal part’s patency by injecting serum saline through the irrigation-aspiration cannula from the fimbrial side of the distal part of the tube. As we can see, the tube is free and no obstruction is detected. We do the same on the left side. We therefore proceed with the anastomosis.

3. Left tubal anastomosis 02'44''

We begin the suturing from the mesosalpingeal part of the edges with non-absorbable 6/0 sutures. We load the serosal layer and go out near and tangential to the tubal lumen. The two edges have different circumferences. We try to make them as congruent as possible by the positioning of the sutures. We take care to have square knots in order to avoid tissue overlap and have a good approximation. The number of sutures that need to be placed depends on achieving congruence between the two suture lines. Again, we perform a methylene blue dye test after the anastomosis to verify tubal patency.

4. Methylene blue test 05'11''

5. Right tubal anastomosis 05'30''

We perform the same procedure on the right side by beginning the first suture on the mesosalpingeal side of the edges. We do exactly the same technique as on the left side.

6. Final aspect 06'46''

At the end of the anastomosis, we can see the final aspect.

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