of Tubal Patency
Division via Laparoscopy
Modified Irving Technique
Sterilization - Ucheda Technique
of the Fallopian Tube
of the Ovary
of the Ovary
Demonstration of Tubal Patency
Modern infertility evaluations are rarely complete
without observation of the Fallopian tube and ovary for disease. Laparoscopy
has replaced culdoscopy as the procedure of choice because it allows
the pelvic surgeon a broader plane of observation, better manipulation
of internal structures, and the ability to electrocoagulate endometrial
The purpose of the operation is to inject a dye through
the uterus and the Fallopian tube to demonstrate patency of the tube.
Physiologic Changes. None.
Points of Caution. Care must be taken to ensure
that there is a watertight seal between the acorn on the cervical
cannula and the surface of the cervix to prevent the dye from leaking
back into the vagina.
As with all laparoscopic diagnostic procedures,
a Rubin cannual and Jacobs tenaculum are applied to the cervix
prior to beginning the procedure. The patient is positioned with
the buttocks at least 4 inches off the end of the operating table.
This is essential if the surgeon is to have proper observation
while injecting indigo carmine solution through the endometrial
cavity into the Fallopian tubes.
Laparoscopy is performed in the routine fashion.
Generally, the one-incision technique is sufficient for adequately
observing the entire pelvis. The Fallopian tubes should be grasped
with a smooth 3-mm forceps and maneuvered into a position where
they can be adequately observed.
Ten mL of indigo carmine solution
are injected through the Rubin cannula in the cervix. The solution
can be observed flowing from the Fallopian tube, or the point
of obstruction can be noted. It is not necessary to remove the
indigo carmine from the abdomen. The instruments are withdrawn,
and the laparoscopy incision is closed in a routine fashion.