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TUBAL REVERSAL SURGERY TECHNIQUE

LAPAROSCOPIC TUBAL LIGATION REVERSAL SURGERY

There are two minimally invasive techniques for tubal ligation reversal: mini-laparotomy and laparoscopic (sometimes using a robot). Laparoscopic tubal ligation reversal is the newer technique to “untie” tubes. Our experienced fertility surgeons, Drs. Williams and Smith, are able to offer this technique that only a relatively small number of physicians are able to perform worldwide.  But we suggest most of our patients choose to have the mini-laparotomy approach with a microscope for the highest chance of success.

Laparoscopy is a minimally invasive surgical technique whereby the anesthetized patient has small incisions made in the abdomen and a camera mounted on a long lens is inserted through the base of the navel to project images on a video monitor. Laparoscopy is an outpatient procedure in nearly all instances. It is utilized in many aspects of gynecologic surgery and its usefulness grows yearly as more gynecologic surgeons apply laparoscopy to more and more types of surgery.

The major advantage to a laparoscopic approach is that the largest incision is only ½ inch in size, compared to about 2 ¼ inch incision (made on the lower abdomen just above the pubic bone) for the mini-laparotomy. But laparoscopy for tubal reversal surgery also requires 5 small incisions, 3 mm, 5mm or 10mm whereas the mini-laparotomy approach has a single 2 ¼ inch incision.  Both surgical techniques (mini-laparotomy and laparoscopy) will allow you to go home the same day but recovery from the laparoscopic approach is approximately 1 week whereas the mini-laparotomy approach requires 2 to 3 weeks of recovery.

 
Laparoscopic Surgery

As described in other parts of this website, tubal reversal surgery by mini-laparotomy has been performed by our surgeons for more than 30 combined years. It uses a microscope and a very delicate technique to remove the scar tissue and reattach the fallopian tubes following tubal ligation.

The laparoscopic approach does not use a microscope but the lens of the camera is able to be placed right up against the surgery site allowing closer inspection.  That being said, the microscope is far superior because it magnifies the view dramatically improving the surgeon’s ability to offer the best repair.  The fallopian tube may be as small as 2 millimeters in diameter so using a microscope greatly improves visualization.  The microscope can only be used with the mini-laparotomy approach. 

Because the laparoscopic approach to tubal ligation reversal is a relatively new technique there is a limited amount of experience worldwide. What research is available indicates that, although the laparoscopic approach does not use a microscope, the pregnancy rates of laparoscopic technique (with or without the “robot”) are not better than the microscopic mini-laparotomy approach. Currently, there is no evidence from randomized controlled trials to demonstrate that a laparoscopic approach is better than a mini-laparotomy approach with the microscope.

We caution all patients that we, personally, believe the old-fashioned mini-laparotomy approach is the most likely way to have the best result.  It is also cheaper.

“Robotic” tubal ligation reversal describes laparoscopy using a robot to assist the surgeon during the procedure. Although this technology simplifies the procedure for surgeons, for the experienced laparoscopist, who already performs tubal ligation reversal without the need for robot assistance, the costs do not appear to justify the use of the robot. Usually, use of the robot increases cost by $2,000 to $3,000. We have considered whether to use the robot for our laparoscopic tubal ligation reversals but nearly all of our patients pay for the procedure themselves (no insurance coverage) and it is not cost-effective to utilize the robot for a procedure we can perform with standard laparoscopy. This is especially true given that there are no research studies indicating that the robot improves pregnancy rates compared to standard laparoscopic technique.

If a center offers you robotic laparoscopic tubal ligation and you are paying out-of-pocket consider whether use of this technology is really necessary. If there are no differences in outcomes why would you want to pay more?  Some doctors are looking to expand their experience using the robot.  Make sure you ask your surgeon how many procedures he/she has performed and compare prices of different approaches.  Ask them about their pregnancy rates using the robot.  Are they as good as mini-laparotomy tubal ligation reversal?

We have the confidence to extend our partial refund guarantee to the laparoscopic tubal reversal surgery patients also. Not everyone is a laparoscopic candidate- with excessive weight being the main limitation to its use. As with mini-laparotomy, not everyone is eligible for the refund guarantee. For instance, some women who had their “tubes tied” with a multiple burn technique may be eligible for tubal reversal surgery but, depending on the extent of the burns, may have a lower chance for success and not be eligible for our refund program. This is an unusual situation because the vast majority of women are eligible for the refund program whether we are “untying” the tubes laparoscopically or by mini-laparotomy.

If your surgeon won’t offer a refund guarantee, why are you confident in the outcome when he or she is not?