- Microresection and
Anastomosis of the Fallopian Tube
Microresection and anastomosis of the Fallopian tube are indicated
in those cases of infertility where tubal obstruction has been diagnosed
by hysterosalpingography and confirmed by laparoscopy. In recent years,
this procedure has been performed by a microtechnique, utilizing fine
suture and magnification with ocular loupes or an operating microscope.
If careful hemostasis and microtechnique can be used, excessive postoperative
scarring and peritubular adhesions can be reduced. Scarring and stricture
formation at the site of the anastomosis can be minimized. This allows
greater motility of the Fallopian tube, giving it a greater chance
of receiving the oocyte, which is transported down the Fallopian tube
to meet spermatozoa emerging from the proximal end of the tube.
Physiologic Change. The Fallopian tube is restored
to its normal function.
Points of Caution. Meticulous hemostatic
technique is essential. To ensure that a proximal portion of tube is
patent, indigo carmine dye is injected via fine-gauge spinal needle
placed through the fundus into the endometrial cavity, with the lower
uterine segment obstructed with a clamp.
The stent used to aid in performing
the anastomosis is removed immediately after the operation.
A double-headed operating microscope with
both surgeons focusing on the intra-abdominal pelvic contents
is shown. Microsurgery of the Fallopian tube requires magnification
to this level. Special eyeglasses and loupes are also helpful
in this technique.
After the abdomen is entered, peritubular
adhesions are totally excised, not lysed, with a microneedle
cautery or fine microscissors. The uterus is elevated into an
ideal operative position by packing off the cul-de-sac with wet
The proximal end of the scarred, distal segment
of Fallopian tube is transected. A fine probe is inserted through
the fimbriae and passed through the open Fallopian tube. A notch
in the probe has been designed to accept a 2-0 Prolene or nylon
The 2-0 Prolene suture is
pulled through the distal segment of the Fallopian tube.
The proximal segment of tube is picked up
and transected with microscissors.
The lower uterine segment
is occluded with a Buxton clamp, and indigo carmine dye is injected
via a 21-gauge spinal needle through the fundus into the endometrial
cavity. Observation of spill from the stump indicates patency
of the cornual portion of the tube.
A 2-0 suture is threaded through the proximal
stump of the Fallopian tube into the endometrial cavity where
it is allowed to coil.
A similar procedure is performed on the opposite
The mesosalpinx of the Fallopian tubes is
anastomosed with interrupted 8-0 Dexon suture via the microtechnique.
After the mesosalpinx has been closed, the
first layer of 8-0 Vicryl suture is placed in a north, south,
east, west position. Care is taken to place the microsuture in
the submucosal layer of the tube and avoid the tubal mucosa when
Approximatley 4 or 5 of these sutures are
placed until the tube is completely closed.
A second layer of 8-0 Dexon suture is placed
through the serosa and outer portion of the muscle of the Fallopian
tube. When tied, the tube is anastomosed in such a manner that
an indigo carmine solution injected into the fundus will flow
through the Fallopian tube. The same procedure is carried out
on the opposite side.
In this sagittal section of the pelvis after
completion of surgery, the pelvis is filled with Hiscon (low-molecular-weight
dextran) to reduce adhesion formation following microsurgery
by creating intra-abdominal ascites, which keeps the various
surfaces separated until mesothelialization is complete. R indicates