Tubal Microsurgery

The first microsurgery using a microscope was done to repair blood vessels by Jules Jacobson of University of Vermont in 1960. Microsurgery has grown in leaps and bounds since then in the hands of ENT Surgeons, Ophthalmologists, Urologists, Gynecologists, Plastic Surgeons and Vascular Surgeons.

Gynecological microsurgery is a well-established technique with widespread applications. It is essentially a technique of awareness and appreciation of the need to restore genital anatomy and adnexal spatial relationship for reestablishment of fertility.

Microsurgery is not a ‘see one, do one’ operation. Success in microsurgery needs patience, perseverance and practice till perfection. Microsurgical skills can be achieved by practicing in the microsurgical laboratory.

Appropriate microsurgical instruments like micro forceps, micro needle holder and micro scissors should be used. Appropriate suture material like 8-0 ethilon, 6-0 ethilon and 6-0 prolene are used with spatulated taper point 6 mm 3/8 circle needle. Operating microscope with 5-40 X magnification or surgical loops with 2-6X magnification are used. Unipolar and bipolar electrodes are also used. Instruments are held by pencilgrip method which allows stable and sensitive fingertip control of instruments.

Indications for tubal microsurgery

Contraindications

1. Extensive adhesions
2. Pelvic tuberculosis
3. Extensive intratubal adhesions
4. Acute pelvic inflammatory disease
5. Unqualified surgeon

Tissues are prevented from drying by constant irrigation with heparinized ringer lactate solution 2500 U in 500 ml RL. Adhesions are prevented by:

1. strictly adhering to principles of microsurgery
2. hydrofloatation and
3. use of corticosteroids. Dexamethasone 32 mg is instilled in peritoneal cavity.

Success in reversal of tubal sterilization is high if standards of tubal sterilization had been adhered to.

Nowadays, there is a trend towards Invitro fertilization for tubal disease. But tubal microsurgery has the advantage of longstanding restoration of fertility, whereby with a single procedure, they can successively have more children without medical assistance. The second most important factor is the low cost. Also, the attendant dangers of hormones like Ovarian hyperstimulation syndrome as in IVF are not seen.

Hence, tubal microsurgery has a definite role in experienced hands for management of infertility, reversal of tubal sterilization and unruptured ectopic pregnancy.

Dr. T. K. Shaanthy Gunasingh, MD, DGO
Programme Director / Core Officer
Centre of Excellence in sterilization and microsurgical recanalization
Professor of O & G, Kilpauk Medical College
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