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laparoscopic tubal recanalization anastomosis tuboplasty infetility ivf Pradeep Garg New Delhi india aiims fallopian tube Microsurgical Tubal Obstruction Tubal sterilization reversal Tubal Obstruction Sterilization Reversal tuberculosis genital
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Laparoscopic Tubal Recanalization
Dr. Pradeep GargAssistant Professor
Dept. of Obst. & GynaeAll India Institute of Medical Sciences, New Delhi
Email:[email protected]
Laparoscopic microsurgery is a new discipline that synergizes the
potential of classical microsurgery and laparoscopy
Introduction
Dr. Pradeep Garg, Assistant Professor, Obs. & Gynae, All India Institute of Medical Sciences, New Delhi
Advantages of Laparoscopic Tubal Recanalization
• All microsurgical principles are well maintained like
magnification, tissue handling, haemostasis & lavage
• Avoids laparotomy & tissue trauma associated with packing &
retractors
• Minimal tissue handling & trauma
• Adhesions are minimal
• Cosmetically far better
• Faster recovery
Dr. Pradeep Garg, Assistant Professor, Obs. & Gynae, All India Institute of Medical Sciences, New Delhi
Indications of Tubal Anastomosis
• Reversal of tubal sterilization procedure
• Mid-tubal block secondary to various pathology
• Tubal occlusion secondary to ectopic pregnancy treatment
• Salpingitis isthmica nodosa
• Failed tubal cannulation for proximal tubal block
Dr. Pradeep Garg, Assistant Professor, Obs. & Gynae, All India Institute of Medical Sciences, New Delhi
Contraindications
• Aged 40 years or older• Decreased ovarian reserve or ovarian failure• Extensive tubal damage• Hydrosalpinx with a diameter of more than 3 cm• Inadequate proximal or distal tubal segment for reanastomosis• Projected tubal length of less than 3 cm after the reconstruction
procedure• Extensive pelvic/peritubal adhesions• Any contraindication to pregnancy or surgery• Severe male factor infertility or male sterility
Dr. Pradeep Garg, Assistant Professor, Obs. & Gynae, All India Institute of Medical Sciences, New Delhi
Instrumentation
• High resolution three-chip camera
• Good light source
• High resolution monitor
• Microsurgical hand instruments
Dr. Pradeep Garg, Assistant Professor, Obs. & Gynae, All India Institute of Medical Sciences, New Delhi
Chromopertubator and injection needle
Dr. Pradeep Garg, Assistant Professor, Obs. & Gynae, All India Institute of Medical Sciences, New Delhi
Suction irrigation cannula and curve monopolar hook
Dr. Pradeep Garg, Assistant Professor, Obs. & Gynae, All India Institute of Medical Sciences, New Delhi
Microneedle holder and micrograsping forceps
Dr. Pradeep Garg, Assistant Professor, Obs. & Gynae, All India Institute of Medical Sciences, New Delhi
Ultramicro scissors
Dr. Pradeep Garg, Assistant Professor, Obs. & Gynae, All India Institute of Medical Sciences, New Delhi
Dr. Pradeep Garg, Assistant Professor, Obs. & Gynae, All India Institute of Medical Sciences, New Delhi
3.5 mm microtrocars with automatic valve
Movie
To see videos on laparoscopic gynae surgeries please logon to
www .youtube.com and type Pradeep aiims
Conclusion
• Laparoscopic microsurgery offers all the benefits of traditional
microsurgery coupled with the inherent advantages of laparoscopy
Dr. Pradeep Garg, Assistant Professor, Obs. & Gynae, All India Institute of Medical Sciences, New Delhi
•MBBS from SNMC Agra in1995•Post graduation in obs gynae from All India Institute of Medical Sciences in 1998•Three years of senior residency in obs and gynae from All India Institute of MedicalSciences in 2001
•Currently working as assistant prof. in All India Institute of Medical Sciences since 2002•Field of interest is gynae endoscopic surgery and infertility•Have many publications in national and international journals•Running endoscopic training centre ( Gynae Endo Training Centre AIIMS) at All IndiaInstitute of Medical Sciences since 2004 and trained more than 200 candidates fromIndia and abroad
•Conducted many laparoscopic workshops as operating faculty in India and abroad
Biodata Dr. Pradeep Garg
