Fertility Microsurgery

What is fertility microsurgery?
Fertility microsurgery is a form of minimally invasive laparoscopic surgery that utilizes specially developed microsurgical instruments to perform highly delicate fertility preserving and restoring procedures on the fallopian tubes while minimizing scarring. Fertility microsurgery is used to treat tubal factor infertility.
What is tubal factor infertility?
The fallopian tubes play an essential role in a woman’s ability to conceive naturally. Each month when a woman ovulates, the delicate finger-like fimbriae at the end of one of the fallopian tubes catches and allows the woman’s egg cells (oocytes) to enter the tube. The oocyte then passes along this very fine tube toward the uterus, during which fertilization may occur with a sperm cell.

The tubes must be open and move freely in order for the woman’s egg cells to successfully enter and pass along the tubes to the uterus. The tubes may fail to function normally for a number of reasons. Sometimes the tubes fail to develop normally, and other times disease, infection, or previous surgery result in one or both tubes becoming damaged. In some cases a woman previously underwent a tubal ligation sterilization to prevent pregnancy but now wishes to become pregnant, requiring a tubal reversal.
When is fertility microsurgery indicated?
If a woman’s fallopian tubes become damaged due to inflammation and scarring or if they failed to develop normally resulting in tubal factor infertility, fertility microsurgery can be performed to reconstruct the tubes, restoring function and allowing the woman to conceive naturally.
What does laparoscopic fertility microsurgery involve?
Laparoscopic fertility microsurgery is a minimally invasive procedure involving small “keyhole” or “Band Aid” incisions that leave two or three tiny scars that are easily concealed by a bikini. Microsurgical tools are used to correct problems with the tubes. The techniques used will vary depending on the cause of tubal infertility.
Microsurgical techniques to treat tubal factor infertility:

  • Lysis of periadnexal adhesions: Removing adhesions (bands of scar tissue) involving the fallopian tubes and ovaries.
  • Salpingostomy: An incision (opening) is made in the tube in order to remove content that is obstructing the tube. The incision is then left to heal naturally. This procedure is sometimes used to treat unruptured ectopic pregnancies.
  • Neosalpingostomy: A new opening (ostium) is made in a tube that is fully blocked by an obstruction.
  • Tubo-uterine implantation: If the proximal portion of the tube (the portion that exits the uterus) is damaged and obstructed, it can be removed and the remaining healthy tube is re-implanted into the uterus.
  • Tubotubal anastomosis: Removal of a segment of abnormal (obstructed) tube and re-connection of the healthy remaining ends back together to form a non-obstructed tube. This procedure is used during tubal-reversals (reversal of previously tied tubes) and is demonstrated in the video below.
  • Fimbriolysis: Separation of the fimbriae (the finger-like appendages at the ends of the tubes) if they are fused by scar tissue.
  • Fimbrioplasty: Repair of partially occluded (blocked) fimbriae and expansion of the surface area of the fimbria in order to increase their ability to catch egg cells released by the ovaries.
  • Tubal cannulation: If a tube is partially obstructed, a fine dilatory instrument may be inserted in order to dilate and open up the tube. This procedure is often performed via hysteroscopy (a procedure whereby a camera and small instruments are inserted through the cervix and into the uterine cavity.

Dr. Koh performed the world’s first laparoscopic tubal anastomosis for the reversal of tubal ligation sterilization. This video demonstrates the delicate techniques involved in restoring tubal function to ligated tubes.

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