Laparoscopic Tubal Sterilization Reversal Update
In 1992,
Drs. Koh and Janik presented the world's first laparoscopic microsurgical tubal
anastomosis for reversal of sterilization. Since that time, this technique has
expanded and a new range of microsurgical laparoscopic instruments have been designed [Koh
ultra-microsurgical instruments] by the Storz Company for worldwide distribution.
The
doctors continue to lecture and perform demonstrations of their technique internationally,
and Dr. Koh was co-chairman of the 1st, 2nd, and 3rd World Conference on Microendoscopy in
Sante Fe 1995; San Francisco 1996, Vancouver 1997, respectively. Doctors from around the
world who attended the meeting are in the early stages in their development and have
started to do some cases in India, Korea, Vietnam, Australia, Europe, and USA.
The
Center continues to perform laparoscopic anastomosis on patients who fly in from across
the nation as well as world wide. link at this point to the MIMIS site with
information on how to come here and this and that.
Seventy
percent of the patients after anastomosis go home or to their hotel the same day of
surgery while the rest stay in the hospital overnight and then are discharged to their
home or their hotel. Out of town patients typically fly in the day before surgery and fly
out two days after surgery.
Since
their first cases in 1992, the doctors have honed their technique such that laparoscopic
anastomosis is now performed within two to three hours. Their latest pregnancy rates are
60% at 6 months and 75% at twelve months having intrauterine pregnancies. The ectopic
pregnancy rate is 6 percent. Recently, there have been innovations such that the umbilical
incision is 5-mm with two other 5-mm incisions and a 3-mm incision for the whole
procedure. Most patients go back to work after a few days.
Laparoscopic Photos of Tubal Anastamosis
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Appearance of sterilized fallopian tube before anastomosis (re-joining) |
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Blind stump has been cut to show healthy end (25X magnification) |
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First 8/0 suture is placed at 6 o'clock position of proximal and distal tubes |
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The stitch has been tied bringing the tube together |
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The anastomosis has been completed after four 8/0 sutures have been placed and tied. Methylene blue dye injected into the uterine cavity emerges from the end of the tube with no leakage at the joint |