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.