Robotic Tubal Reanastomosis

November 9, 2018

Robotic Tubal Reanastomosis

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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