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Gynecology

Find all the surgical interventions, lectures, experts opinions, debates, webinars and operative techniques per specialty.
Principles of tubal surgery
This presentation focuses on the specific advantages of tubal surgery as compared to assisted reproductive techniques (ART).
Tubal surgery is a valid option in selected cases.
This selection is only possible through endoscopy and a precise knowledge of lesions is necessary. Three kinds of lesions have to be precisely known: pelvic adhesions and tubal lesions, either distal or proximal.
Nowadays, a special focus has to be made on subtle tubal lesions which were underestimated until recently.
Diagnosis and patient selection is a key factor and it is best achieved through transvaginal endoscopy such as fertiloscopy.
Even if today laparoscopy is the gold standard to treat tubal abnormalities, the principles of microsurgery which were defined a long time ago have to be strictly applied if one wants to get a pregnancy rate equivalent or superior to what is expected with in vitro fertilization (IVF).
A Watrelot
Lecture
4 years ago
1743 views
78 likes
0 comments
16:07
Principles of tubal surgery
This presentation focuses on the specific advantages of tubal surgery as compared to assisted reproductive techniques (ART).
Tubal surgery is a valid option in selected cases.
This selection is only possible through endoscopy and a precise knowledge of lesions is necessary. Three kinds of lesions have to be precisely known: pelvic adhesions and tubal lesions, either distal or proximal.
Nowadays, a special focus has to be made on subtle tubal lesions which were underestimated until recently.
Diagnosis and patient selection is a key factor and it is best achieved through transvaginal endoscopy such as fertiloscopy.
Even if today laparoscopy is the gold standard to treat tubal abnormalities, the principles of microsurgery which were defined a long time ago have to be strictly applied if one wants to get a pregnancy rate equivalent or superior to what is expected with in vitro fertilization (IVF).
Laparoscopic tubo-cornual anastomosis for reversal of sterilization
This video shows a case of tubo-cornual anastomosis for reversal after tubal sterilization. A 43-year-old patient has requested a reversal of sterilization. She already had 4 deliveries. On the hysterosalpingography, one can see that Hulka clips are really near the uterine horns.
The video demonstrates the removal of Hulka clips, the dissection of the interstitial part of the tube, the catheterization of a guide through the ostium in the proximal, then distal part of the tube hysteroscopically, and finally a tubo-cornual anastomosis. In our opinion, the quality of the anastomosis directly depends on the complete congruence of the two tubal stumps. Different prognostic factors have been discussed in previous studies (e.g., age, type of sterilization (clips or coagulation), length of remaining tube, and site of anastomosis). According to the literature, the best anastomotic site, in terms of successful pregnancy, would be the isthmic-isthmic position. In our experience, the use of a tubal hysteroscopic guide seems the best aid to obtain a luminal alignment and it is more comfortable for the suture.
O Garbin, L Schwartz
Surgical intervention
4 years ago
2805 views
107 likes
1 comment
08:01
Laparoscopic tubo-cornual anastomosis for reversal of sterilization
This video shows a case of tubo-cornual anastomosis for reversal after tubal sterilization. A 43-year-old patient has requested a reversal of sterilization. She already had 4 deliveries. On the hysterosalpingography, one can see that Hulka clips are really near the uterine horns.
The video demonstrates the removal of Hulka clips, the dissection of the interstitial part of the tube, the catheterization of a guide through the ostium in the proximal, then distal part of the tube hysteroscopically, and finally a tubo-cornual anastomosis. In our opinion, the quality of the anastomosis directly depends on the complete congruence of the two tubal stumps. Different prognostic factors have been discussed in previous studies (e.g., age, type of sterilization (clips or coagulation), length of remaining tube, and site of anastomosis). According to the literature, the best anastomotic site, in terms of successful pregnancy, would be the isthmic-isthmic position. In our experience, the use of a tubal hysteroscopic guide seems the best aid to obtain a luminal alignment and it is more comfortable for the suture.