The feasibility of reduced sutures in 3D laparoscopic tubal sterilization reversal.

Autor: Li PC; Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital; Buddhist Tzu Chi Medical Foundation; Tzu Chi University, Hualien, Taiwan., Ding DC; Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital; Buddhist Tzu Chi Medical Foundation; Tzu Chi University, Hualien, Taiwan; Institute of Medical Sciences, Tzu Chi University; Hualien, Taiwan. Electronic address: dah1003@yahoo.com.tw.
Jazyk: angličtina
Zdroj: Journal of gynecology obstetrics and human reproduction [J Gynecol Obstet Hum Reprod] 2022 Dec; Vol. 51 (10), pp. 102473. Date of Electronic Publication: 2022 Sep 10.
DOI: 10.1016/j.jogoh.2022.102473
Abstrakt: Study Objective: To show the technique of reduced sutures in 3D laparoscopic tubal reanastomosis.
Design: Step-by-step demonstration of the procedure using video.
Setting: Laparoscopic tubal sterilization reversal demands high precision and requires both skill and experience. Conventionally, 4 to 6 interrupted patterns using 6-0 to 8-0 absorbable sutures are used for laparoscopic tubal reanastomosis. We used fewer and larger sutures under a magnified 3D view to perform the procedure.
Interventions: We presented a case of a 42-year-old woman, gravida 3, para 3, who underwent tubal sterilization during Cesarean section 10 years ago. Preoperative hysterosalpingography (HSG) showed bilateral distal tubal occlusion. The procedure started with the subserosal injection of diluted vasopressin in both proximal and distal ends and in the mesosalpinx to facilitate dissection and hemostasis. After transection of tubal stump and removal of scar tissue, we used a 3 Fr ureteral catheter as the stent to facilitate suturing. Three interrupted 4-0 monocryl sutures were used for suturing both tubal mucosal and muscular layers at 6, 2, and 10 o'clock sites. We performed bilateral ampullo-ampullary reanastomosis. The tubes were successfully reanastomosed, and patency was confirmed by chromotubation performed at the end of the procedure (Figure 1). The operation lasted for 71 minutes. The operative blood loss was less than 50 ml. Patent right fallopian tube was confirmed on postoperative HSG 1 month later. The patient had a successful pregnancy 8 months after the operation.
Conclusion: Our experience shows the feasibility of 3D laparoscopy for tubal reanastomosis using reduced sutures. The technique alleviates the damage to the fallopian tube. The operative time, hospital stay, and postoperative adhesions were significantly lower than the conventional method with a comparable success rate.
Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest.
(Copyright © 2022 Elsevier Masson SAS. All rights reserved.)
Databáze: MEDLINE
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