12473 Laparoscopic Tubal Re-Anastomosis: A Stepwise Approach and Evidence-Based Considerations

To demonstrate a step-by-step approach to performing a laparoscopic tubal re-anastomosis and provide evidence for perioperative considerations. Surgical video with evidence-based commentary of laparoscopic tubal re-anastomosis following a tubal ligation with Filshie clips and a recent unsuccessful laparoscopic tubal re-anastomosis. Operating theatre with routine operative laparoscopy set up with addition of a microsurgical suprapubic port. A 39-year-old female who had a previous Caesarean section and bilateral tubal ligation with Filshie clips was referred to a fertility subspecialist after a previously unsuccessful tubal re-anastomosis. Laparoscopic tubal re-anastomosis can be performed with the following nine steps: 1. Diagnostic laparoscopy to visually inspect anatomy and clear any adhesions 2. Gentle coagulation to tubal serosa to reduce bleeding risk 3. Stripping of tubal serosa from underlying tissue 4. Amputation of proximal and distal tubal obstructions 5. Identification of tubal lumen and mucosa 6. Application of an anchor suture to the mesosalpinx 7. Re-anastomosis: suturing of proximal and distal ends, incorporating mucosa and muscularis layers 8. Closure of serosal layers and supportive suturing 9. Confirmation of tubal and anastomosis patency The surgical video demonstrates a successful and evidence-based approach to a laparoscopic bilateral tubal re-anastomosis following tubal ligation and previous unsuccessful tubal ligation. An evidence-based and logical stepwise approach to tubal re-anastomosis can be a safe and effective option for fertility following tubal ligation.