Microsurgical reversal of female sterilization.

Academic Article

Abstract

  • As mentioned recently in an excellent article by Dr. Gomel, intraoperative chromopertubation is an invaluable aid in reconstructive tubal surgery. Unfortunately, the inherent clumsiness and risk of infection associated with the transcervical approach he advocates and the difficulty involved in placing and maintaining a rigid needle tipe in the uterine cavity transfundally make both of these commonly-used techniques less than optimal. Recently we developed a modification of the conventional transfundal method of intraoperative chromopertubation that seems to circumvent these difficulties. In place of an 18-gauge needle, we use an 18- or 20-gauge Teflon intravenous catheter to enter the uterine cavity. The catheter-needle unit is placed through the fundus to a point thought to be in the uterine cavity, and the catheter is gently slid off the needle. If resistance is met, the catheter tip is most likely in the myometrium, and it is repositioned until the catheter does slide off easily. Alternatively, the needle-catheter unit can be placed at full length into the uterus and the needle withdrawn. At this point, the catheter is slowly withdrawn while an attempt is made at dye injection. When injection can be accomplished with minimal resistance, the tip is in the uterine cavity, and the catheter can then be advanced further into this space if desired. Now, with the aid of a lower uterine segment clamp, a length of intravenous extension tubing and a syringe, tubal patency can be fully evaluated. In addition, the catheter can be left in place throughout the repair with a minimal amount of trauma in order that at the end of the case, repeat dye injection can be done to evaluate the integrity of the repair. Also, gentle hydropertubation with an appropriate therapeutic solution can be carried out at this time if desired. author's modified
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    Digital Object Identifier (doi)

    Author List

  • Hurd WW; Reich MI; Barnes AE
  • Start Page

  • 122
  • End Page

  • 123
  • Volume

  • 36
  • Issue

  • 1