Tubal Reversal

 

Worldwide, more than 153 million women have chosen sterilization as their contraception method. As many as 20% will subsequently express regret after a change in family circumstances. Of these women, up to 5% will request sterilization reversal.

 

Currently, most tubal reversals are performed through a traditional laparotomy incision (open incision) using microsurgical techniques. Success rates, defined as term pregnancy rates, have been reported between 33% to 85%. The disadvantages of laparotomy include longer hospital stay, longer recovery and increased need for pain medication.

 

The da Vinci technology now allows surgeons to perform sterilization reversals with all the advantages of minimally invasive procedures with far more precision than conventional laparoscopy. This translates into shorter hospital stay, with most patients returning home the same day as surgery. It also leads to lesser post-operative pain and a significantly more rapid return to normal daily activities.

 

Success rates with the da Vinci tubal reversal are comparable to the traditional laparotomy with rates as high as 74% viable live pregnancies.

 

 

Table 1.  Pregnancy Outcome for Tubal Anastomosis by Robotic Compared With Outpatient Minilaparotomy11

 

 

Robotic
(n=23)

Laparotomy
(n=33)

p

Time to conceive (months after surgery)

2

4

0.13

Number of patients conceiving after surgery

14 (61)

26 (79)

0.10

Total number of pregnancies

19

47

 

Ectopic pregnancies

2 (11)

6 (13)

.70

Spontaneous abortion

3 (16)

18 (38)

.26

Viable intrauterine pregnancies

14 (74)

23 (49)

.31

Tried other infertility treatment

7 (30)

10 (31)

.82

 

Data are median and n, (%)
P < 0.05 is statistically significant

 

Many factors may influence the success rate of tubal reversal including the age of the patient, the sterilization technique used, time from sterilization and final length of the reconstructed tube.

 

The surgical procedure consists in removing abnormal tissue from the 2 portions of the tube and to reapproximate the healthy tubal segments with microsuturing. The enhanced visualization and the improved dexterity provided by the da Vinci surgical system allow for greater precision required in tubal reanastomosis.

 

 

Ask Dr Rivard and her team if you are a good candidate for a robotic da Vinci tubal reversal and let the dream begin…

REFERENCES

  1. UNDP/UNFPA/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization. Advances in female sterilization research. Prog Reprod Health Res News 1995:36:1. Available at: http://www.who.int/reproductive-health/hrp/progress/35/prog35.pdf. Accessed on August 16,2007.
  2. Hillis SD, Marchbanks PA, Tylor LR, Peterson HB. Post sterilization regret: findings from the United States Collaborative Review of Sterilization. Obstet Gynecol 1999; 93:889-95.
  3. Spivak MM, Librach CL, Rosenthal DM. Microsurgical reversal of sterilization: a six year study. Am J Obstet Gynecol 1986; 154:355-61.
  4. Divers WA Jr. Characteristics of women requesting reversal of sterilization. Fertil Steril 19984; 41:233-6.
  5. Siegler AM, Hulka J, Peretz A. Reversibility of human sterilization. Fertil Steril 1985; 43:499-510.
  6. Posaci C, Camus M, Osmanagaoglu K, Devroey P.  Tubal surgery in the era of assisted reproductive technology: clinical options. Hum Reprod 1999; 14:120-36.
  7. Winston RM. Reversal of tubal sterilization. Clin Obstet Gynecol 1980; 23:1261-8.
  8. Silber SJ, Cohen R. Microsurgical reversal of female sterilization: the role of tubal length. Fertil Steril 1980; 33:598-601.
  9. Rock JA, Guzick DS, Katz E, Zacur HA, King TM. Tubal anastomosis: pregnancy success following reversal of Falope ring or monopolar cautery sterilization. Fertil Steril 1987;48:13-7
  10. Rodgers AK, Goldberg JM, Hammel JP, Falcone T. Tubal Anastomosis by Robotic Compared with Outpatient Minilaparotomy. Obstet Gynecol 2007; 109:1375-1380.
  11. Patel SPD, Steinkampf MP, Whitten SJ, Malizia BA. Robotic tubal anastomosis: surgical technique and cost effectiveness. Fertil Steril 2008; 90:1175-1179.