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Gynecology

Find all the surgical interventions, lectures, experts opinions, debates, webinars and operative techniques per specialty.
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
2812 views
108 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.