AUTHOR-DR A.R. ANAND [PROF & HOU]

PRESENTOR– DR UMA TRIPATHI (JUNIOR

RESIDENT)

Tuboplasty is surgical approximation of

tubal segment after tubal sterilisation or

excision of an occluded or diseased portion

of fallopian tube.

Tuboplasty through minilaprotomy incision is

a new discipline that synergizes the potential

of classical microsurgery and laparoscopy.

To study the success of tubal recanalisation

procedure through minilaprotomy

Reversal of tubal sterilization procedure in

case of untimely death of child or children

Remarriage

All the pt which were requesting for tubal recanalisation for above mentioned reason for tubal ligation

Pt with husband semen analysis with in normal limit

Other obvious causes of female infertility ruled out.

Male infertility

Female requesting for tubal renanalisation

after having live baby of either sex & staying

with them

Other chronic debilitating illness

Pt with previous 2 cesarian section

All the pt fullfilling the above mentioned

criteria

Duration of study : 2010 to 2014

Study area :JJ hospital , Mumbai

Pt were posted for surgery after all

preoperative workup.

Postoperatively pt were followed up with

HSG report after 3 month

Tuboplasty is done through minilaprotomy

incision along with micro-technique using

fine instruments with fine suture material

[vicryl 6-0] .

Written informed consent taken

Patient was placed in lithotomy position

Cervical catheterisation done with foley’s

catheter no 8

Pt taken in supine position

Parts painted and draped

Small transverse incision [2-2.5 cm ]taken

over suprapubic area

Abdomen opened in layers

One side of fallopian tube traced with the

help of babcock’s forcep and delivered

outside abdomen

Two ends of previous tubal ligation site

identified ,edges freshened up ,patency of

tubes checked after methylene blue dye was

injected through cervical catheter .

First mesosalphinx is approximated at 6 o clock position on both the sides i.e. anterior & posterior.

First suture was taken with 6-0 polyglactin(vicryl) in the muscles.

Second suture was taken at 3 & 9 o’clock with the same material.

Third suture was taken at 12 o’clock.

Serosa was sutured in continuous manner .

Tubal patency checked by injecting methyleneblue dye through cervical catheter and spillage checked at fimbrial end.

And patency confirmed .

Then fallopian tube reposited in abdomen

Same procedure repeated on opposite side

Opposite Tubal patency checked by injecting

methylene blue dye through cervical

catheter and spill checked at fimbrial end .

Microsurgical principles are well maintained like magnification, tissue handling, haemostasis & lavage

Less tissue handling & trauma

Adhesions are less

Less postoperative pain

Faster recovery

Early ambulation

Cosmetically better scar

In our study, 38 patient underwent

tuboplasty through minilaparotomy access on

day 5 hydrotubation 30 cases [79% ] had

bilateral spillage and 8 cases [21% ] had

spillage in unilateral tube .

Pt is asked to follow up in opd after 3 months

with HSG report.

Out of 38 patient, 36 cases came for follow

up with HSG report which showed bilateral

tubal patency in 28 cases [78%] and 8 cases

[22%] had unilateral tubal patency.

Earlier Tuboplasty was done through conventional laparotomy access, which was associated with more tissue injury, foreign body contamination of peritoneal cavity, higher post-operative pain, adhesions and slower rehabilitation.

Latter with advancement of laparoscopy, Laparoscopic Tuboplasty started, although it is associated with minimal tissue injury, less adhesions and faster recovery but it requires longer operative time, risk of visceral injury and need for general anesthesia with expertise in laparoscopic technique.

Tuboplasty done through Minilaparotomy

incision offers combined advantage of both

conventional and laparoscopic recanalization

This technique offer precise tissue

alignment, which can be confirmed with

direct tactile feedback.

Easier operative technique due to no

requirement of in depth surgery.

Less adhesions, post operative pain and

equivalent recovery period as compared with

laparoscopic technique.

Surgical scar even smaller than laparoscopic

technique (i.e. combined multiple port site

scar)

Definitely Minilap Tuboplasty have

advantages of

Safer in high risk patients

Can be done in regions where laparoscopic

facility is not available

Smaller learning curve

3-Dimensional surgery with tactile feedback

Along with carrying advantage of laparoscopic

surgery i.e. earlier recovery and better cosmetic

scar.