- MEDICINE ATHENS MED4WOMAN ATHENS
- MEDICINE VOLOS MED4WOMAN VOLOS
Obstetrician - Gynaecologist
Doctor of Medicine, University of Athens Medical School
Panagiotis Polyzos, Gynaecologist Obstetrician, is active at the Institute of Life - IVF Unit of Iaso Maternity Hospital.
Laparoscopic surgery can be used for many surgical procedures on the fallopian tubes, such as:
Many of these procedures are conservative and involve reconstruction of the fallopian tubes and ovaries to preserve fertility. These microsurgical techniques are performed to improve fertility, enhance it, and restore it. Comparisons of similar surgical procedures on the fallopian tubes and ovaries show a significant superiority when performed laparoscopically instead of via laparotomy (less blood loss, faster and easier recovery, and reduced cost).
Below, we will analyze some of the most important gynecological laparoscopic procedures performed on the fallopian tubes.
Tubal reanastomosis or tubal reversal:
A surgical method used to reverse tubal ligation, which may be an option for women who, for various reasons, wish to restore their fertility. Tubal ligation is a procedure previously performed to prevent future pregnancies by surgically tying or burning the fallopian tubes, thereby preventing the passage of eggs from the ovaries to the uterus.
The success of this procedure depends on several factors, such as the length and health of the remaining segments of the fallopian tubes that are to be reconnected, the surgeon’s skill, knowledge, and experience, as well as the woman’s age at the time of the reversal procedure. Restoring tubal patency offers a high likelihood (but not a guarantee) of pregnancy, provided that the fallopian tubes are healthy and no other infertility factors are present. Under optimal conditions, the pregnancy rate can reach 75–80%. The probability of success and the time to conception after tubal reanastomosis surgery are influenced by various factors. In most cases, conception occurs within the first year following the procedure.
Tubal anastomosis is a two- to three-hour operation performed under general anesthesia. Typically, laparoscopy is first performed to assess whether the fallopian tubes are suitable for reversal. If conditions are appropriate, a small transverse incision is made just above the pubic hairline. An operating microscope is used to reconnect the tiny ends of the fallopian tube with very fine sutures.
The risks are extremely rare, but as with any surgical procedure, they include anesthesia-related complications, the possibility of bleeding, infection, or injury to surrounding organs. After tubal reversal, the risk of ectopic pregnancy (tubal pregnancy) increases from 1 in 100 to 5 in 100 pregnancies.
FTR reopens your fallopian tubes if they are blocked. It does not always require surgery.
How is it performed?
Dr. gynecologist will not need to make any incisions during FTR. A speculum will be used to keep your vagina open, and then a small plastic tube or catheter will be inserted through your cervix into your uterus. A contrast dye is then injected through the catheter, followed by an X-ray of your uterus and fallopian tubes to identify the exact location of the blockage. Finally, a second, smaller catheter is used to clear the obstruction. Generally, this procedure is performed in a selected number of patients with specific types of tubal blockage.
Risks
There are several risks associated with this procedure. First, because the procedure uses X-ray contrast dye and radiation, potential complications may occur.
Salpingostomy — sometimes called neosalpingostomy or fimbrioplasty — is a procedure in which your gynecologist creates an opening in the blocked fallopian tube. The blocked and swollen tube, known as a hydrosalpinx, is always filled with fluid.
How is it performed?
During the procedure, your gynecologist will open the fallopian tube and remove the blockage, while trying to keep the tube as intact as possible. The incision is left open so the tube can heal naturally.
In contrast to the salpingostomy procedure, which repairs the blocked fallopian tube and leaves it largely intact, salpingectomy involves removing the tube during surgery. Your gynecologist may recommend a bilateral salpingectomy, meaning the complete removal of both fallopian tubes, to improve your chances of success with in vitro fertilization (IVF).
How is it performed?
There are several ways in which your gynecologist can perform a laparoscopic salpingectomy. One method involves using a pre-tied surgical loop and tightening the knot around the fallopian tube to remove it. Another method is the cauterization and destruction of the blood vessels within the tube.
Your gynecologist may recommend a fimbrioplasty procedure if you have a blockage in the part of the fallopian tube that is closest to the ovary. This procedure opens the blocked tube and preserves the tissue known as fimbriae, allowing your eggs to move through the tube.
How is it performed?
The fimbriae are small finger-like projections at the end of the fallopian tubes that function to capture the egg once it is released from the ovary. Fimbrioplasty is usually performed as part of a salpingostomy. In addition to clearing the blockage in the tube, your gynecologist will essentially reconstruct the fimbriae.
