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Tubal ligation is the most common form of female contraception worldwide; however, a significant number of women regret their decision for permanent sterilization. Future conceptions after tubal ligation require assisted reproductive technology (ART) with in vitro fertilization or tubal anastomosis surgery. With microsurgical technique and proper patient selection, tubal anastomosis has greater success for achieving live birth than ART. Minimally invasive surgery confers significant benefits for patients; however, the microsurgical techniques and delicate tissue handling required for tubal anastomosis are more challenging than with open procedures. Robot-assisted laparoscopic tubal anastomosis overcomes these challenges and is a viable alternative, applying the same tissue handling principles as open microscopic procedures.

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...

Study Objective To demonstrate a technique for tubal anastomosis. Design A video description of steps of a technique for minimally invasive tubal anastomosis. Setting video description of surgical technique using robotic assistance. Patients or Participants 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. Interventions Laparoscopic tubal anastomosis with robotic assistance. Measurements and Main Results Description of surgical technique using surgical video. Conclusion tubal anastomosis using robotic assistance is a reproducible minimally invasive approach.

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.

El presente trabajo se realizó en el Servicio de Infertilidad del Hospital Arzobispo Loayza. Se presenta 45 casos de mujeres infértiles con factor tubario. Todas las pacientes contaron con histersalpingografía. Dentro los antecedentes primaron el aborto, la enfermedad pélvica inflamatoria y la cirugía pélvica, el 24% no tenía antecedente alguno, 4 pacientes habían tenido TBC genital. Las técnicas quirúrgicas empleadas fueron, reimplante cornual y salpingolisis, fimbriostomía y anastomosis tubaria, 10 pacientes llegaron a gestar, 2 de estas gestaciones fueron embarazos ectópicos, una paciente con TBC genital tratada tuvo 2 embarazos normales.

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.

Resume Nous rapportons deux cas de reanastomose tubaire proximale en cœlioscopie robot-assistee apres ligature tubaire proximale. Les patientes etaient âgees respectivement de 43 et 34 ans et avaient beneficie d’une ligature tubaire proximale par coagulation section pour la premiere et clips de Filshie pour la seconde a 37 et 24 ans. Leurs cycles etaient reguliers ovulatoires et leur reserve ovarienne etait bonne. Leurs conjoints presentaient des criteres spermatiques normaux. La reanastomose tubaire proximale a ete realisee en septembre 2010 par cœlioscopie robot-assistee avec cinq points extramuqueux de vicryl 5-0 sur chaque trompe et epreuve au bleu positive. La duree totale de l’operation etait respectivement de 200 et de 220 minutes. Les suites operatoires ont ete simples et les patientes ont ete enceintes spontanement a quatre et 2,5 mois. Les grossesses sont actuellement normoevolutives. Nous etayons les donnees de la litterature afin de definir la place de la robotique dans la reanastomose tubaire proximale.

Robotic trachelectomy after neoadjuvant chemotherapy with simultaneous tubal anastomosis may be an option in stage IB2 cervical cancer patients., Introduction: The aim of this study was to report a case of cervical cancer stage IB2 treated with neoadjuvant chemotherapy, followed by simultaneous robotic-assisted radical trachelectomy and reversal of tubal sterilization. Case Description: This case occurred in a university hospital involving a 31-y-old woman with stage IB2 cervical cancer treated using neoadjuvant chemotherapy, robotic surgery, and tubal anastomosis to determine cancer disease status and achieve restoration of tubal patency. Discussion: A successful radical trachelectomy with patent tubes was done bilaterally. Cancer and fertility procedures can be simultaneously implemented and achieved.

The authors conclude that robotic technology can facilitate the performance of robotic tubal anastomosis., Objectives: To describe the surgical technique of robotic tubal anastomosis. Methods: Retrospective chart and video review of the instrumentation and methodology used for robotically assisted tubal anastomosis. Results: All tubal anastomoses were performed with the use of 3 or 4 robotic arms, 3 or 4 robotic instruments, and 1 assistant trocar. Conclusions: Robotic technology facilitates the performance of robotic tubal anastomosis.

To compare tubal anastomosis by robotic system compared with outpatient minilaparotomy.In this retrospective case-control study, women were identified by current procedural terminology code for tubal anastomosis. We included all cases of tubal anastomosis for reversal of a prior tubal ligation by either outpatient minilaparotomy or robotic system technique. Cases performed by laparoscopy without aid of the robot were excluded. Comparisons were based on Fisher's exact, chi(2), and Wilcoxon rank sum tests.There were 26 cases of tubal anastomosis performed with the robot and 41 cases performed by outpatient minilaparotomy. The two groups were comparable in age, body mass index, and parity. Anesthesia time for the robotic technique (median with interquartile range) was 283 (267-290) minutes compared with 205 (170-230) minutes with outpatient minilaparotomy (P.001). Surgical times for the robot and minilaparotomy were 229 (205-252) minutes and 181 (154-202) minutes respectively (P=.001). Hospitalization times, pregnancy, and ectopic pregnancy rates were not significantly different. The robotic technique was more costly. The median difference in costs of the procedures was $1,446 (95% confidence interval $1,112-1,812) (P.001). The time to return to work was significantly shorter in the robotic system group by approximately 1 week (P=.013).Robotic surgery for tubal anastomosis was successfully accomplished without conversion to laparotomy. The robotic technique for tubal anastomosis required significantly prolonged surgical and anesthesia times over outpatient minilaparotomy (Por=.001). Costs were higher with the robotic technique. Return to normal activity was shorter with the robotic technique.

Microsurgical fallopian tube anastomosis is a procedure to restore fertility in women who underwent tubal sterilization or excision of an occluded or diseased portion of tube. With proper selection of patients, this procedure restores fertility with excellent results and allows to avoid disadvantages associated with other popular treatment options including in vitro fertilization and assisted reproductive technology. The outcome of repair is highly dependent on the skill and dedication of the surgeon. Various laboratory models have been described in literature for practicing microsurgical fallopian tube anastomosis. This chapter outlines the rat model for fallopian tube anastomosis. Animal preparation, microsurgical technique, patency evaluation and common pitfalls that may be encountered during repair are described.

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.

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.

As with standard microsurgical procedures performed at laparotomy, laparoscopic tubal anastomosis requires great dexterity. Handling fine suture materials under magnification to anastomose tubal segments with lumens less than 3 mm in diameter while working with your hands at a distance from the tissue makes these fine movements even more difficult. This is exacerbated by the tremor induced by the fatigue caused by a prolonged laparoscopic procedure and the need for precise control. We conducted a pilot study to evaluate the feasibility of performing laparoscopic tubal anastomosis with robotic assistance in a live porcine model. Two anastomoses were performed on one uterine horn via each of the following techniques: laparoscopy, laparoscopy with robotic assistance, and open microsurgery. Immediate necropsy demonstrated all the anastomoses to be patent. There were no intraoperative complications. Laparoscopic tubal anastomosis was associated with surgeon fatigue and neck, shoulder, and back pain. The surgeons were more comfortable performing the procedure with robotic assistance. The device functioned well and without incident. This acute animal study suggests that robotic assistance in laparoscopic tubal anastomoses is safe and feasible. It enhances surgeons' dexterity and precision while reducing fatigue. It is promising for future use in chronic experimental studies.

To determine the interest of using robotic laparoscopic surgery in the management of female infertility, we reviewed our own activity and searched the Medline database for publications on robotic technology in infertility surgery, with the use of the following search words: robotic laparoscopy, tubal anastomosis, myomectomy, deep infiltrating endometriosis, and adnexal surgery. Robot-assisted laparoscopic surgery has seen rapid progression over the past few years. It has been mostly used for myomectomy, proximal tubal reanastomosis, and deep endometriosis surgery. Despite its increased range of indications, no randomized control studies are available. The place of robotic surgery in the management of infertility remains undetermined.

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.

We compared the results of tubal anastomosis performed by a microsurgical technique and by the application of cyanoacrylate, a tissue adhesive agent. Forty Spraque-Dawley female rats were ...

Study Objective. To determine the length of procedure, length of hospital stay, complications, and postoperative pregnancy rates of traditional tubal anastomosis (TA) and laparoscopic-assisted TA (LATA). Design. A comparison of 8 women undergoing LATA with 11 patients operated on by the same surgeon during a similar time period who were not candidates for, or did not desire, a laparoscopic approach. Setting. Academic practice tertiary care setting. Patients. Women requesting reversal of tubal ligation. Interventions. Tubal anastomosis by laparoscopy or laparotomy. Measurements and Main Results. Patients undergoing the two procedures did not differ by age or parity, although those selected for LATA had a lower body mass index (23.2±1.4 vs 30.8±2.0 kg/m 2 , p=0.01). Although the LATA took longer (251±14 vs 194±10 min, p=0.004), hospital stay was significantly shorter than for traditional TA (1.8±0.3 vs 3.0±0.1 days, p=0.004). Of the eight LATAs, six were completed and two were converted to laparotomy. For all patients with follow-up, clinical pregnancy rates were 43% and 29% (NS) for TA and LATA, respectively, with 100% of the former and 80% (NS) of the latter group who did not conceive having at least one patent tube on hysterosalpingogram. Conclusions. Laparoscopic-assisted TA is a possible alternative to the traditional TA performed by laparotomy. Ideal candidates for LATA appear to be women without obesity and with proximal tubal segments of 3 cm or greater. Larger studies with longer follow-up will define appropriate candidates and identify long-term results.

In einer gynakologisch-psychosomatischen Studie wurden 33 Frauen nach Refertilisierung und/oder IvF nach Tubensterilisation untersucht. Als Kontrollgruppe diente eine Zufallsstichprobe von 45 Frauen nach Tubensterilisation. Wir verwendeten als psychometrische Instrumente ein halb-strukturiertes, themenzentriertes Interview und den Giessen-Tcst. Nach den Hauptindikationen fur die Refertilisierung wurden 2 Gruppen gebildet: 21 Patientinnen hatten einen neuen Partner (R-Partner), 12 gaben Verlusterlebnisse an (R-Verlust). Soziodemographisch waren die Gruppen gut vergleichbar, bei psychischen Variablen zeigten sich relevante Unterschiede, so z.B. die Motivation zur und Bedenkzeit vor der Sterilisation sowie die Altersdifferenz zwischen den Partnern. Frauen der R- Partner-Gruppe waren mit der Refertilisierung/IvF signifikant zufriedener als R-Verlust-Frauen, die Zufriedenheit war weitgehend unabhangig von einer danach eingetretenen Schwangerschaft. Die beiden Methoden IvF und Refertilisierung wurden in einer je spezifischen Weise erlebt. Die Cluster-Analyse der Giessen-Test-Ergebnisse bestatigte die Gruppeneinteilung. Aus den obigen Ergebnissen schliesen wir, das Verlusterlebnisse als Hauptindikation fur eine Refertilisierung einen ungunstigen Prognose-Parameter darstellen. Bei Frauen mit Wunsch nach Wiederherstellung des gestorten Korperbildes hat die IvF eine ungunstige Prognose. Praoperative Beratung durch eine/n psychotherapeutisch Ausgebildete/n erscheint uns unabdingbar. In a psychosomatic study we interviewed 33 women who had undergone tubal anastomosis or IvF after tubal ligation. As a control group we chose a randomised sample of 45 women after elective tubal ligation. We used a semi-structured interview and the Giessen-test as psychometric instruments. According to the leading indication for reanastomosis, we allocated women to one of 2 groups: 21 patients had found a new partner (R-partner), 12 mentioned experiences of loss (R-loss). The groups were well comparable in respect of sociodemographic items, but showed relevant differences in psychological variables, like motivation for and time for deliberation to sterilisation or age difference between partners. Women of the R-partner group were highly satisfied with tubal reanastomosis as compared to R-loss subjects. Satisfaction with the procedure was basically independent of an actual pregnancy. Women experienced the two methods in different, rather specific ways. Cluster analysis of the Giessen-test result confirmed group allocation. We conclude that experiences of loss as a leading reason for tubal reanastomosis are unfavourable prognostic factors. IvF has an unfavourable prognosis in women with the intention to restore the mutilated body image. Preoperative counselling by a psychotherapeutically trained counsellor seems mandatory.

Laparoscopic surgery was the minimally invasive diagnostic and treatment procedure of choice in this rare form of ectopic pregnancy., The incidence of ectopic pregnancy in the general population is approximately 1%. This risk increases to 5% following tubal anastomosis. Ectopic pregnancy may cause life-threatening hemorrhage. Morbidity and mortality associated with an extrauterine pregnancy are directly related to the length of time required for diagnosis and treatment. Laparoscopy is the gold standard for surgical management in these cases. This report deals with the case of a rare form of ectopic pregnancy following tubal anastomosis.

We conducted a restrospective chart review of 22 laparoscopic tubal anastomoses performed between May 1987 and May 1991. The procedures were modeled after the two-stitch technique of Swolin. Overall fertility rates were disappointing in this small series, although the first live birth has occurred. The two-stitch method and available laparoscopic suture needles and needle holders limited the surgical results. Modifications of technique and instrumentation should improve fertility outcome.

To evaluate various techniques for restoring tubal patency after sterilisation.A search strategy was designed, and for each subject either thesaurus terms (MeSH descriptors) or terms from the title or summary were used.Mean length of hospital stay following laparoscopy seems to be shorter in comparison with laparotomy (3.3 vs. 6.1 days, P0.05). Rate of conversion to laparotomy is 5%. Pregnancy rates observed are between 54 and 88% for laparotomy and 31-85% for laparoscopy. Mean time to conception was between 2 and 9.6 months. Most pregnancies occurred in the 2 years following restoration of tubal patency (cumulative conception rate 80% at 12 months). Young age (35 years), type of ligature (rings), how recently the ligature was done (8 years), the anastomosis site (in the middle of the tube) and a good length of remaining tube (7 cm) are the factors that govern whether there can be good restoration of tubal patency. Ectopic pregnancy rates observed are between 1.7 and 12% for laparotomy and 0-7% for laparoscopy. There are no randomised or quasi-randomised studies comparing tubal anastomosis and in vitro fertilization.There are few good-quality controlled studies in this area. Results of restoration of tubal patency seem to be comparable, regardless of the route of approach (laparotomy or laparoscopy).

Antecedentes: Los avances en las técnicas de cirugía laparoscopia han permitido a cirujanos entrenados realizar reanastomosis tubaria bilateral por laparoscopia, reportando resultados similares a los de la técnica vía laparotómica. Objetivo: Evaluar una nueva técnica de reanastomosis tubaria llamada "técnica de tres puntos". Método: Se realiza estudio retrospectivo que evalúa 5 casos de pacientes con antecedentes de esterilización quirúrgica, a quienes se les realizó reanastomosis tubaria laparoscópica con la técnica de tres puntos. Resultados: La edad promedio de las pacientes fue de 35,8 ± 5,7 años (rango: 26-40 años); 80% (8/10) de las trompas fueron reanastomosadas. En dos pacientes la reanastomosis fue unilateral por segmento distal ausente de la trompa contralateral. El tiempo promedio de duración de la cirugía fue de 150 ± 7,9 minutos (rango: 140-160 minutos). La tasa de embarazo fue de 40% (2/5). Los embarazos se produjeron en las pacientes más jóvenes y con reanastomosis bilateral. En aquellas que no lograron embarazo se realizó histerosalpingografía verificándose el 100% de las trompas reanastomosadas permeables. Background: Advances in endoscopio surgical techniques have allowed well-trained and skilled surgeons to perform tubal anastomosis by laparoscopy reporting similar results than by laparotomy. Objective: To evalúate a new technique we called "three-stitch method". Method: The outcomes for this evaluation were tubal patency and pregnancy rate. A retrospective analysis of five cases of previous tubal sterilization underwent endoscopio tubal reanastomosis using the "three-stitch technique" was done. In all patients a preoperative hysterosalpingogram was performed to confirm occlusion. Results: The average age was 35.8 ± 5.7 years (rango: 26-40 years). All the patients underwent previous tubal sterilization (four cases using Pomeroy technique and one case with Yoon Ring). Eighty percent (8/10) of tubes were reanastomosed. In two cases, due to inadequate conditions of distal or proximal ends of one tube, surgery was performed on the other only. The average surgical time was 150 ± 7.9 minutes (range 140-160 minutes). The pregnancy rate was 40% (2/5). Pregnancy was achieved in younger patients who underwent bilateral reanastomosis. In those patients where pregnancy was not accomplished, a hysterosalpingography was taken to evalúate tubal patency. All of the reanastomosed tubes showed tubal patency at six months follow-up.

To compare cost and efficacy of tubal anastomosis to in vitro fertilization (IVF) in women who desired fertility after a tubal ligation.Cost-effectiveness analysis.Not applicable.Not applicable.Not applicable.Cost per ongoing pregnancy.Cost per ongoing pregnancy for women after tubal anastomosis ranged from $16,446 to $223,482 (2014 USD), whereas IVF ranged from $32,902 to $111,679 (2014 USD). Across maternal age groups35 and 35-40, years tubal anastomosis was more cost effective than IVF for ongoing pregnancy. Sensitivity analyses validated these findings across a wide range of ongoing pregnancy probabilities as well as costs per procedure.Tubal anastomosis was the most cost-effective approach for most women less than 41 years of age, whereas IVF was the most cost-effective approach for women aged ≥41 years who desired fertility after tubal ligation. A model was created that can be modified based on cost and success rates in individual clinics for improved patient counseling.

Antecedentes: La esterilización tubárica se realiza en un número importante de pacientes jóvenes que por diferentes motivos desean posteriormente un nuevo embarazo, porcentaje que varía entre el 1,3-15%. Hasta ahora la cirugía ha sido la primera alternativa de tratamiento y gracias a la evolución de la técnica y el desarrollo de material quirúrgico, es posible de realizar por vía laparoscópica. Objetivos: Hacer una síntesis de la historia y técnicas utilizadas en la reanastomosis tubárica, los criterios de selección, el estudio preoperatorio, los factores pronósticos y comparar los resultados de la laparotomía y la laparoscopia. Métodos: Se realiza búsqueda en base de datos Medline PubMed usando las palabras clave: tubal anastomosis, reversal of esterilization, infertility, microsurgery, tubal esterilization; se seleccionan todas aquellas publicaciones tipo review de reanastomosis tubárica con microcirugía abierta y todas aquellas de reanastomosis por vía laparoscópica. Resultados: La reanastomosis tubárica por laparotomía con técnica microquirúrgica tiene un éxito entre 60 y 90% de tasas de embarazo. Las primeras publicaciones de la técnica laparoscópica no presentan resultados satisfactorios, sin embargo casuísticas más numerosas y especialmente las que muestran la técnica microlaparoscópica tienen resultados similares con todas las ventajas de la laparoscopia. Conclusión: La recanalización tubaria por vía laparoscopica es una técnica factible, probada y exitosa, alternativa a la laparotomía, sin embargo, para su implementación con resultados satisfactorios es necesario contar con equipamiento apropiado, experiencia previa en cirugía abierta y entrenamiento en cirugía endoscópica 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 reversal is a feasible, tested and successful alternative to the traditional surgery performed by laparotomy, however, to achieve a successful outcome it is necessary a meticulous surgical technique, adequate equipment and extensive experience with tubal anastomosis by laparotomy and advances laparoscopic techniques

Study Objective To compare the costs of tubal anastomosis performed by laparoscopy and by laparotomy. Design Cost analysis study using the hospital administrative database (Canadian Task Force classification II-2). Setting University teaching hospital. Patients Eighty-nine women. Intervention Tubal anastomosis by laparoscopy (43) and by laparotomy (46). Measurements and Main Results Tubal 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 Conclusion Laparoscopic tubal anastomosis costs less than tubal anastomosis by laparotomy.

Objective: To evaluate the feasibility and safety of a robotic device to perform a laparoscopic tubal anastomosis. Design: Prospective pilot study. Setting: Tertiary care medical center. Patient(s): Ten patients with previous tubal ligations underwent laparoscopic tubal ligation reversal using a robotic suturing device. Intervention(s): Tubal surgery was performed with a robotic system. A two-layered closure was used for all tubes. Four stitches of 8-0 polygalactin sutures were used for each layer. Main Outcome Measure(s): Tubal patency; secondary measures were pregnancy rates, complications, and operative time. Result(s): The procedure was completed successfully in all 10 patients. No patient required conversion to an open procedure. The mean time (±SD) required to complete the anastomosis of both tubes was 159 ± 33.8 minutes. Chromotubation at the end of the procedure showed patency in all tubes anastomosed. A postoperative hysterosalpingogram 6 weeks after surgery demonstrated patency in 17 of the 19 (89%) tubes anastomosed. There have been five pregnancies so far. There were no complications. Conclusion(s): Robotic technology can be used safely to create laparoscopic microsurgical anastomoses with adequate patency rates. Robotic technology has the potential to make laparoscopic microsuturing easier.

The results of the present study suggest that there is no difference in adhesion formation and PR after tubal anastomosis using sutures or fibrin sealant. It appears that the use of fibrin sealant is associated with decreased incidence of ectopic pregnancy.

Optical magnification and long instrumentation significantly increase surgical tremor, which makes laparoscopic microsuturing difficult. Therefore, laparoscopic tubal anastomosis has not gained wide acceptance among gynecologic surgeons. Robotic assistance facilitates this type of procedure by filtering tremor, reducing the surgeon's fatigue, and scaling the maneuvers. The authors have successfully completed a case of laparoscopic tubal reanastomosis using a "master-slave" robot to perform the standard microsuturing technique. A 33-year-old woman, gravida 2, para 2, requested reversal of her previous tubal ligature. A right isthmic-isthmic tubal anastomosis was performed laparoscopically, with faithful adherence to the authors' standard technique applied at laparotomy. Full robotic assistance was used to anastomose the tube. A chromotubation test showed anastomotic patency without leak. The patient recovered uneventfully after surgery and was discharged within 24 h after the procedure. Laparoscopic microsurgical tubal anastomosis with full robotic assistance is feasible and safe in humans.

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.

We have studied a group of 19 patients presenting with proximal tubal occlusion. Seventy-three percent (22/30) of tubes attempted were successfully cannulated. Sixty-two percent (5/8) of tubes remained patent in limited follow-up at 3 to 6 months. We conclude that selective fallopian tube cannulation may provide an alternative to microsurgical tubal anastomosis in selected patients.

Os autores descrevem sua experiência em recanalização tubária videolaparoscópica pós-laqueadura em 10 pacientes, tratadas no período de junho de 1994 a fevereiro de 1996. A duração da 1ª cirurgia foi de 4 horas e 30 minutos e da última foi de 2 horas e 30 minutos. A metade das recanalizações foi ístmo-ístmica. O tamanho mínimo das tubas restantes foi de 4 cm de cada lado e os fios utilizados para a sutura foram o 7-0 e 6-0 monofilamentares, derivados do ácido poliglicólico. A permeabilidade tubária foi verificada pela histerossalpingografia 3 meses após a cirurgia e, como resultado, 88, 8% das tubas operadas estavam permeáveis. Quatro das pacientes consideradas aptas para engravidar ficaram grávidas durante o período de seguimento. O tempo médio de permanência hospitalar foi de 24 horas. Não houve complicações cirúrgicas ou anestésicas.

Despite the advent of newer methods of contraception and reformulated oral contraceptives, female voluntary sterilization remains popular. Although this is presented as a permanent method of sterilization, traditional micro-surgical techniques have allowed more than 60% of women requesting reversal of sterilization to carry an intrauterine pregnancy.(1),(2) Like most of the gynecologic procedures, tubal re-anastomosis can also be performed laparoscopically.

Operations for fertility include tubal anastomosis and salpingostomy, with or without salpingolysis and ovariolysis. In six women an isthmo-isthmic tubal anastomosis was performed. The edges of the serosa of the two ends of the oviducts were approximated and the anastomosis was covered with Tisseel. One patient became pregnant and patency was proved in another three patients.

A case of laparoscopic reversal of tubal sterilization is reported. The patient was a 38 year old woman sterilized by bipolar diathermia two years earlier. Refertilization was performed by laparoscopic end to end anastomosis of one tube. Postoperatively, the patient had one menstruation and then achieved an intrauterine pregnancy. The laparoscopic method of refertilization saves expensive hospitalization costs.A 38-year-old woman, who had a normal delivery at age 29 and a Cesarean section at age 35, underwent laparoscopic adhesiolysis the next year because of pain. Later that year, a laparotomy was performed to remove the left adnex because of a hemorrhagic corpus luteum. During this operation, she underwent sterilization by bipolar coagulation and division of the right tube. 6 months later, her 2-year-old daughter died of hemophilus meningitis. The next year, she was admitted to the hospital several times because of pain in her lower abdomen. She decided to undergo refertilization. The operative technique involved insertion of a Foley catheter into the uterine cavity. Laparoscopic adhesiolysis was performed, and blue dye was flushed through the catheter. The medial end of the right tube was cut off in thin slices until dye passed through the lumen. The lateral part of the tube was then cut, and hemostasis was secured by point monopolar diathermia. The portions of the tube were mobilized slightly and adapted by 2 sutures in the muscularis and 1 in the serosa. Blue dye was flushed through the tube to demonstrate patency. The pelvic cavity was rinsed with Ringer's solution, with about 300 ml left in the abdomen. No antibiotics or steroids were administered. The operation took 90 minutes, and the patient left the hospital the next day. She was able to return to work without using any sick leave. 22 days after the operation, she had a normal menstruation and she achieved an intrauterine pregnancy in the following cycle. A lack of funds in the Norwegian public health service has led to a debate about the necessity of providing the so-called "luxury" procedures of refertilization and infertility surgery. The traditional operative methods are expensive and require between 5 and 7 days of hospitalization. In order to determine whether traditional laparotomy with microsurgical end-to-end anastomosis of the tube or laparoscopic refertilization is more effective, a comparative, randomized study will be necessary.

Laparotomy has been replaced by endoscopic procedures for several indications in classical abdominal surgery. It is widely accepted that pelviscopic surgery plays a key role in the therapy of ectopic pregnancy [1, 8, 11], of endometriosis [9], of salpingo-ovariolysis [2, 6], and of salpingostomy [5, 9]. However, the use of endoscopic surgery for tubal reconstruction seems to be limited, especially in cases when microsutures are required for tubal anastomosis.

An endoscopic technique for tubal anastomosis has been developed in a rat uterine horn model. Uterine segments were anastomosed endoscopically in a training device for surgical pelviscopy ('Pelvitrainer') by fibrin glue, using an inlaying splint as a guide. The anastomoses were accomplished by a seromuscular 6-0 suture at the anti-mesenteric border. Morphological studies revealed good patency of the anastomosed segments without stenoses or occlusions. The tissue continuity was good. In only two cases out of the 20 studied was a tapering of the uterine wall found adjacent to the anastomosis. It is concluded that this endoscopic technique for tubal anastomosis presents a useful alternative to classical microsurgical reversal of sterilization by laparotomy.