Task Analysis of Laparoscopic Fallopian Tubal Recanalization
Task Analysis of Laparoscopic Fallopian Tubal Recanalisation
DR.LAKSHMI SREE ATMURI [ MS OBGY, F.MAS, D.MAS]
TUBAL RECANALISATION:
Surgical approximation of tubal segment after tubal sterilization or excision of an occluded or diseased portion of the fallopian tube
INDICATIONS: Desire for fertility
REQUIREMENTS:
Normal semen analysis
Age more than 40yrs
Tubal sterilization previously by modified Pomeroy, fallopian rings, Filshie Clips
HSG to assess the length of the fallopian tube
CONTRAINDICATIONS:
Age more than 40 yrs
Decreased ovarian reserve
Ovarian failure
Extensive tubal damage
Tubal length less than 3cm
Severe male factor infertility
IMPORTANCE:
Respect to the delicate nature of the tissue
Minimum use of energy sources
Irrigate abdominal cavity with normal saline to minimum drying or adhesion
PROCEDURE:
- Patient in lithotomy position under general anesthesia
- Foleys catheterization
- Check veress needle for its spring action and patency
- Take 2allis forceps to evert and hold each side of umbilicus
- Use number 11 blade to place small horizontal stab wound on the inferior crease of umbilicus
- Mosquito artery to dissect subcutaneous adipose tissue and expose rectus sheath
- Measure abdominal wall thickness and add 4cm for distance to hold veress needle
- Veress needle should be held like a dart
- Lift suprapubic part of abdominal wall with the left hand
- Insert veress needle in stab incision with 45-degree elevation angle and distal end pointed towards anus and perpendicular to the abdominal wall
- The surgeon can hear 2 click sound and maintain the 45-degree angle
- Confirm correct veress needle placement by irrigation test, aspiration test, and hanging drop test
- Connect carbon dioxide gas tube to veress needle
- Check quadromanometry for intraperitoneal placement of veress needle
- Ideal preset pressure of 12mmhg, maximum of 15mmhg
- The flow rate of 1lit/min
- Check uniform distension of abdomen and obliteration of liver dullness
- Once pneumoperitoneum is achieved remove veress needle
- Take cannula of 10mm and mark its impression on the skin
- Extend incision to the size of cannula impression
- Introduce 10mm port by holding it like a piston, perpendicular to the abdomen
- Confirm intraabdominal placement of port by escaping air sound and audible click
- Take out trocar
- Set flow rate increased to 6lit/min
- Connect gas tubing to the primary port
- Insert telescope
- Inspect entry point to exclude any bowel or vessel injury
- Request for Trendelenburg of 30-degree position
- Perform diagnostic laparoscopy with special attention to tubes
- Insert uterine manipulator to aid ease of suturing fallopian tubes
- Secondary and tertiary port placement with help of baseball diamond principle
- Ipsilateral port placement may be desired
- Vasopressin 5IU diluted in 20ml normal saline is injected into mesosalpinx with help of aspiration needle
- Dissecting scissors in the dominant hand
- Maryland forceps on another hand
- Excise occluded area of the tube
- Freshen up the ends of the fallopian tube
- Minimize injury to mesosalpinx
- Preferred suture 4-0 vicryl cutting edge needle
- First Mesosalpinx is to be approximated, to prevent tension over the tube and also anastomosis becomes easy
- Surgeon knots to be applied
- Avoid torsion of tube
- Avoid catching tube directly with a grasper or any other instrument
- Seromuscular sutures are placed at 6, 10, 2* clock position on right fallopian tube
- Seromuscular sutures are placed at 6, 10, 2* clock position on left fallopian tube
- Patency of the tube can be checked
- stop insufflation
- remove all ports under the vision
- close port sites 10mm port with help of veress needle, or port closure devices
4 COMMENTS
Dr. Monika Sen
#1
May 21st, 2020 2:58 am
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Dr. Jamie Enannuel
#2
May 22nd, 2020 4:40 am
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Dr. Sunitha Dhar
#3
Apr 28th, 2021 10:59 am
Enjoyed reading the article on Laparoscopic Fallopian Tubal Recanalization task analysis., really explains everything in detail, the article is very interesting and effective. Thanks.....
Dr. Sheela
#4
Apr 28th, 2021 11:15 am
Thank you so much for article.This really helped me understanding the basics step of Total Laparoscopic Hysterectomy. Task Analysis of Laparoscopic Fallopian Tubal Recanalization
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