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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front Med    2011, Vol. 5 Issue (3) : 310-314    https://doi.org/10.1007/s11684-011-0152-8
RESEARCH ARTICLE
Fertility outcome analysis after modified laparoscopic microsurgical tubal anastomosis
Jihui Ai, Pei Zhang, Lei Jin, Yufeng Li, Jing Yue, Ding Ma(), Hanwang Zhang()
Department of Gynecology & Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Abstract

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.

Keywords modified laparoscopy      tubal anastomosis      microsurgery     
Corresponding Author(s): Ma Ding,Email:dma@tjh.tjmu.edu.cn; Zhang Hanwang,Email:hwzhang605@126.com   
Issue Date: 05 September 2011
 Cite this article:   
Jihui Ai,Yufeng Li,Jing Yue, et al. Fertility outcome analysis after modified laparoscopic microsurgical tubal anastomosis[J]. Front Med, 2011, 5(3): 310-314.
 URL:  
https://academic.hep.com.cn/fmd/EN/10.1007/s11684-011-0152-8
https://academic.hep.com.cn/fmd/EN/Y2011/V5/I3/310
Study periodMarch 2000 and March 2010
No. of cases58
Ageβ(year)33.23±β4.12 (27-44)
Interval from sterilization8.15
to operation (year)
Tab.1  Clinical characteristics of the patients
Fig.1  Trocar site diagram. (A) The previous laparoscopy tubal anastomosis: one 5-mm trocar was placed at the left Lee-yellow, and two were positioned at areas of the right McBurney point and 3 cm above the pubic symphysis. (B) The modified laparoscopy tubal anastomosis: one puncture point was reduced (the left Lee-yellow) based on the previous. One 5-mm trocar was placed at the fold line of the left abdominis rectus outer edge, and another on the intersection of the abdominal wall fold line and white line.
Fig.2  Schematic diagram of the wall and serosa suture. (A) The previous laparoscopy tubal anastomosis: the suture line was tightened after the slipknot is done. (B) The modified laparoscopy tubal anastomosis: the suture line was tightened one after another after all the knots had been completed.
No. of operations58
No. of follow-up patientsa42b
Overall pregnancy rate (%)73.8%β(31/42)
Intrauterine pregnancy (%)c69.0%β(29/42)
Spontaneous abortion (%)7.14%β(3/42)
Ectopic pregnancy (%)4.8%β(2/42)
Delivery (%)83.9%β(26/31)
The pregnancy rate related to the time after operation
6 months23.8%β(10/42)
12 months57.1%β(24/42)
24 months66.7%β(28/42)
36 months73.8%β(31/42)
Tab.2  Pregnancy outcome of the modified laparoscopic microsurgical tubal anastomosis
1 Kim SH, Shin CJ, Kim JG, Moon SY, Lee JY, Chang YS. Microsurgical reversal of tubal sterilization: a report on 1118 cases. Fertil Steril 1997; 68(5): 865-870
doi: 10.1016/S0015-0282(97)00361-0 pmid:9389817
2 Yoon TK, Sung HR, Cha SH, Lee CN, Cha KY. Fertility outcome after laparoscopic microsurgical tubal anastomosis. Fertil Steril 1997; 67(1): 18-22
doi: 10.1016/S0015-0282(97)81849-3 pmid:8986677
3 Koh CH, Janik GM, Sutton C. Laparoscopic microsurgery: current and future status. Curr Opin Obstet Gynecol 1999; 11(4): 401-407
doi: 10.1097/00001703-199908000-00007 pmid:10498027
4 Yoon TK, Sung HR, Kang HG, Cha SH, Lee CN, Cha KY. Laparoscopic tubal anastomosis: fertility outcome in 202 cases. Fertil Steril 1999; 72(6): 1121-1126
doi: 10.1016/S0015-0282(99)00425-2 pmid:10593394
5 Garcia CR. Oviductal anastomosis procedures. In: Richard RM, Prager DJ. Human sterilization. Springfield, IL: Thomas Charies C . 1972: 116
6 Koh CH, Janik GM. Laparoscopic microsurgical tubal anastomosis: results of 40 consecutive cases. In: Program and Abstracts of the 52nd Annual Meeting of the American Society for Reproductive Medicine. Boston, MA. November 2 , 1996
7 Dubuisson JB, Chapron C. Single suture laparoscopic tubal re-anastomosis. Curr Opin Obstet Gynecol 1998; 10(4): 307-313
doi: 10.1097/00001703-199808000-00005 pmid:9719882
8 Schepens JJ, Mol BW, Wiegerinck MA, Houterman S, Koks CA. Pregnancy outcomes and prognostic factors from tubal sterilization reversal by sutureless laparoscopical re-anastomosis: a retrospective cohort study. Hum Reprod 2011; 26(2): 354-359
doi: 10.1093/humrep/deq326 pmid:21115505
9 Tan HH, Loh SF. Microsurgical reversal of sterilisation — is this still clinically relevant today? Ann Acad Med Singapore 2010; 39(1): 22-26
pmid:20126810
10 Kaloo P, Cooper M. Fertility outcomes following laparoscopic tubal re-anastomosis post tubal sterilization. Australian New Zealand J Obstet Gynaecol . 2002; 42(3): 256-258
doi: 10.1111/j.0004-8666.2002.00256.x
11 Ribeiro SC, Tormena RA, Giribela CG, Izzo CR, Santos NC, Pinotti JA. Laparoscopic tubal anastomosis. Int J Gynaecol Obstet 2004; 84(2): 142-146
doi: 10.1016/S0020-7292(03)00203-0 pmid:14871516
12 Dharia Patel SP, Steinkampf MP, Whitten SJ, Malizia BA. Robotic tubal anastomosis: surgical technique and cost effectiveness. Fertil Steril 2008; 90(4): 1175-1179
doi: 10.1016/j.fertnstert.2007.07.1392 pmid:18054354
13 Falcone T, Goldberg JM, Margossian H, Stevens L. Robotic-assisted laparoscopic microsurgical tubal anastomosis: a human pilot study. Fertil Steril 2000; 73(5): 1040-1042
doi: 10.1016/S0015-0282(00)00423-4 pmid:10785235
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