Tubal sterilization is one of the most common methods of birth control used by women world over. It is, however, a permanent method of contraception and as many as 5%of the couples opting for tubal ligation will subsequently express regret over the decision after a change in the family circumstances which may be improved economic situation, change in marital partner , desire for more children .
In rare circumstances the death of a child may prompt women to seek reversal of sterilization .Patients who opted for tubal ligation as a method of contraception at a younger age are more likely to regret their decision . Patients who desire reversal of tubal sterilization have many options and surgery has an important role in the management of these patients.
While IVF has made great strides in efficacy and patient acceptability reanastomosis of the tubal segment is an attractive option for couples who have no other fertility issues and want to avoid the risk of multiple pregnancies. Traditionally, the reversal was done through a laprotomy incision where a microsurgical tubal reanastomosis was performed.
However this technique has the disadvantage of increased postoperative hospitalization and need for analgesia which has lead some reproductive surgeons to opt for minimally invasive surgery (laparoscopy) for this procedure.
However laparoscopic tubal reanastomosis is a technically challenging surgery and it is no surprise that it was one of the first surgeries for which robotic assistance was described.
Many people believe that when they opt for a robotic surgery it is the robot who operates. It is the surgeon, actually who performs the surgery and uses a controller to operate instruments which are placed inside the patient just prior to starting surgery.
The robot has two parts, one is on the patients side called as the robot and the other is the surgeon’s console. The robot has several arms one of which is a camera and the others are specialized surgical instruments with unique capabilities like grasping, cutting.
For a robotic reversal the surgeon sits several feet away from the patient at the surgeon’s console and look inside a vision hood where they are able to see the same image that the robotic camera can see. This camera gives the surgeon enhanced visualization, true depth of field and a panoramic view, .The instruments on the patient’s side can then be controlled by the surgeon for performing the surgery .
The robotic hands allow a broad range of movement and hence greater dexterity while reconstructing the delicate fallopian tube thereby safely restoring fertility.
Robotic surgery offers the advantage of increased range of motion , enhanced vision and increased accuracy of suture placement and better delineation of tissue planes improved tubal reapproximation critical to a successful reanastomosis , and mechanical precision which projects into multiple benefits for the reproductive surgery patient such as : less blood loss, less postoperative surgical pain and hence lower requirement of analgesia, ,quicker recovery and return to normal activities, lesser scarring.
Pregnancy rates after robotic reanastomosis have been reported as high as 80%. In comparison to larger abdominal incision, minimally invasive surgery has been associated with decreased pain , lower infection rates quicker recovery times. Regardless of the approach, the type of tubal ligation remains a key factor in the success of reversal surgery with Falope’s ring and Filschie clips yielding the best chance of successful reversal.
The Pomeroy method of tubal ligation provides varied results and is dependent on the location of ligation and whether equal diameters of tube are available for reconstruction.
In life there are a number of things that cannot be undone but tubal ligation is not one of them .While there are several factors that affect the success the success of reanastomosis, the women who want to expand their family have a number of options available to them including the robotic approach, which has become an integral part of the minimally invasive surgical armametrium.
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