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. 2004 Oct-Dec;8(4):334-8.

Experience of laparoscopic tubal surgery at the department of obstetrics and gynecology, University of Kiel, from 1999 through 2000

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Experience of laparoscopic tubal surgery at the department of obstetrics and gynecology, University of Kiel, from 1999 through 2000

Thoralf Schollmeyer et al. JSLS. 2004 Oct-Dec.

Abstract

Objective: We analyzed the results of laparoscopic tubal surgery performed at the Department of Obstetrics and Gynaecology, University of Kiel, between 1999 and 2000. A retrospective review of 236 tubal surgical procedures was conducted: (1) patients with ectopic pregnancies, unilateral or bilateral tubal occlusions or alterations and (2) medically indicated sterilizations and salpingectomies.

Methods: Two specialists and 10 gynecologists in residency training performed the following 236 procedures: 64 salpingotomies, 74 salpingectomies, 25 salpingostomies, 8 tubal end-to-end anastomoses, 24 fimbrioplasties, and 41 tubal sterilizations. In June 2001, questionnaires were sent to all 236 patients who underwent laparoscopic tubal surgery to evaluate subsequent pregnancies. From the 195 answers received, 155 patients wished to have children and of these 79 (51%) became pregnant. In 8 tubal reversals, 6 pregnancies occurred, resulting in a 75% success rate. In the group of sterilizations and salpingectomies, no pregnancies occurred.

Results: A pregnancy rate of 51% resulted after tubal reconstructive surgery. After tubal sterilization, no pregnancies were observed in the following 3 years.

Conclusion: Laparoscopic tubal surgery has surpassed laparotomic tubal surgery with comparable success rates. Laparoscopic tubal surgery is also a less traumatic procedure.

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Figures

Figure 1.
Figure 1.
Laparoscopic tubal surgical techniques performed at the Department of Gynecology and Obstetrics, University of Kiel, 1999–2000. A. Salpingotomy with local application of the vasopressin derivative, coagulation strip, incision with the microscissors, extraction of pregnancy product and suture. B. Salpingectomy. The resection of the tube is carried out as close as possible to the uterine tubal junction. After placing a loop around the tube, the Roeder loop is closed, the tube dissected from the uterine tubal junction and the stump coagulated. C. Salpingostomy. In cases of peripheral tubal occlusion, inject the vasopressin derivative, incise with the microscissors, invert the fimbria, and suture. D. Fimbrioplasty. A blunt dilation of stenosed fimbria is performed with atraumatic forceps entering into the tubal ostium, opening the forceps and dilating the ostium. E. Tubal sterilization. With endocoagulation or bipolar coagulation, the tube is coagulated approximately 1 cm distal to the uterine tubal junction and dissected with scissors. This procedure is performed bilaterally.
Figure 2.
Figure 2.
Tubal end-to-end anastomosis. Performed with the 2-stitch technique uniting the muscularis and the peritoneum. A. Screening laparoscopy. B. Slice resection of occluded tubal area. C. Hysteroscopic tubal canalization. D. Mesosalpinx adaptation suture. E. Muscularis anastomosis suture. F. Final adaptation of tubal ends. G. Application of tissue col and retraction of hysteroscopic catheter. H. Chromopertubation.

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