Tubal Ligation Reversal Procedures
The most successful tubal ligation reversal procedures involve the use of microscopic techniques so that the tubal ends are visible clearly and stitches are placed properly. The following surgical procedures are used to perform tubal ligation reversal:
Tubotubal anastomosis: Tubal ligation surgery leaves the Fallopian tubes with two segments – the proximal segment emerging from the uterus and a distal segment ending into the fimbria next to the ovary. The blocked ends of the remaining tubal segments are opened to recreate a functional tube with the help of different microsurgical techniques. The newly formed tubal openings are brought closer and sutures are placed in the connective tissue lying below the Fallopian tubes. The retention suture prevents the tubal segments from getting pulled apart during the course of healing of the tube.
Tubal re-implantation: In a few cases, only the distal segment of the Fallopian tube is left after the tubal ligation surgery. It can happen if the tubal ligation is applied at the isthmic portion of the Fallopian tube as it emerges from the uterus.
A new opening is created through the uterine muscle in women who do not have the proximal tubal segment. The remaining part of the tubal segment after creating the new opening is inserted into the uterine cavity. This microsurgical procedure is known as tubal re-implantation.
Neofimbrioplasty: Tubal ligation may also be performed by removing the fimbria of the Fallopian tube (fimbriectomy) but in rare cases. Fimbriectomy leaves only the tubal segment attached to the uterus. Neofimbrioplasty can be used to reverse the tubal ligation if the remaining tubal segment is long enough to open the tube and to create a new fimbria. The newly created fimbria is actually the cilia from the inner portion of the Fallopian tube. The tubal end is opened and folded back so that it remains open keeping the internal line of the tube exposed.
Mini-laparotomy tubal reversal: This surgical procedure for the reversal of tubal ligation is conducted by making tiny incisions of size ranging from 2 to 4 inches. The incision is placed just above the pubic bone, which leaves the scar almost invisible after healing. Local anesthesia is administered to minimize the post-operative pain and make the surgical procedure complacent. Recovery time is reduced greatly with this procedure and the patient can get back to work after one week of the surgery.
Laparoscopic tubal reversal: It is a minimally invasive procedure which involves the creation of an incision in the abdomen of the patient. The patient is administered anesthesia before the procedure. A camera is inserted through the base of the navel to get live images on a computer.
The Fallopian tubes of the patient are examined and evaluated for any obstruction, which is removed with the help of three small instruments. The two segments of the Fallopian tube are prepared to be reconnected. A blue dye is injected through the cervix of the patient after completing the connection to confirm the proper alignment of the tubes.
Robot-assisted tubal reversal: Robot-assisted surgery enables the surgeons to use even smaller instruments, which results in a faster recovery. It is the least invasive technique for tubal reversal surgery but is quite expensive also. Robot-assisted tubal ligation reversal uses the same technique with smaller incisions as used in the traditional laparotomy tubal reversal surgery.
Robot-assistance helps the surgeon achieve higher dexterity and a greater range of motion. This procedure takes longer but it also ensures several advantages such as shorter hospital duration and faster recovery with quick return to daily routine activities.
Essure sterilization reversal: Essure surgery uses a small camera, which is inserted into the uterine cavity through the cervix of the woman. Two metallic coils are introduced into the isthmic portion of the Fallopian tube to block it. To reverse the Essure sterilization procedure, the blocked isthmic portion is bypassed. This is done by using the tubal re-implantation technique as mentioned above.
