This video highlights the technique for robotic-assisted laparoscopic tubal reanastomosis

Design:

Surgical video

Setting:

This surgery was performed at a tertiary teaching hospital

Patients or Participants:

38-year-old gravida 2 para 2 with prior bilateral tubal ligation at the time of her second cesarean delivery, now desiring future fertility.

Interventions:

The patient underwent robotic-assisted laparoscopic bilateral tubal re-anastomosis and myomectomy. Two posterior pedunculated fibroids were excised. The proximal and distal ends of the fallopian tubes were cut transversely. Fine dissection was performed to ensure the muscularis layer was opened. Chromopertubation with methylene blue was performed to confirm patency from the proximal ends. A 5-French Neonatal feeding tube was used to confirm patency from the distal ends. One stay suture was placed at the junction between the mesosalpinx and the 6 o'clock portions of the tubes that were to be approximated. The fallopian tubes were then reapproximated using a 2 layer technique: sutures were placed incorporating the muscularis layer at 3, 9, 12 and 6 o'clock with 6-0 polyglactin 910. The serosal layer was reapproximated in a circumferential manner using 6-0 poliglecaprone-25 suture. The stay suture was then removed. This was performed bilaterally.

Measurements and Main Results:

Chromopertubation with methylene blue was performed and patency of the fimbriated ends was confirmed with no spillage at the anastomotic sides.

Conclusion:

Optimal exposure, decreased blood loss, ease of suturing, and comparable rates of pregnancy to laprascopic surgery, make robotic assisted laparoscopic technique an excellent option for tubal reanastomosis