Design: Surgical video with evidence-based commentary of laparoscopic tubal re-anastomosis following a tubal ligation with Filshie clips and a recent unsuccessful laparoscopic tubal re-anastomosis.
Setting: Operating theatre with routine operative laparoscopy set up with addition of a microsurgical suprapubic port
Patients or Participants: A 39-year-old female who had a previous Caesarean section and bilateral tubal ligation with Filshie clips was referred to a fertility subspecialist after a previously unsuccessful tubal re-anastomosis.
Interventions: Laparoscopic tubal re-anastomosis can be performed with the following nine steps:
- Diagnostic laparoscopy to visually inspect anatomy and clear any adhesions
- Gentle coagulation to tubal serosa to reduce bleeding risk
- Stripping of tubal serosa from underlying tissue
- Amputation of proximal and distal tubal obstructions
- Identification of tubal lumen and mucosa
- Application of an anchor suture to the mesosalpinx
- Re-anastomosis: suturing of proximal and distal ends, incorporating mucosa and muscularis layers
- Closure of serosal layers and supportive suturing
- Confirmation of tubal and anastomosis patency
Measurements and Main Results: The surgical video demonstrates a successful and evidence-based approach to a laparoscopic bilateral tubal re-anastomosis following tubal ligation and previous unsuccessful tubal ligation.
Conclusion: An evidence-based and logical stepwise approach to tubal re-anastomosis can be a safe and effective option for fertility following tubal ligation.
Vo, S*, Lok, D. Liverpool Hospital, Sydney, NSW, Australia