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Antoine WATRELOT

Hôpital Natecia
Lyon, France
MD
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Principles of tubal surgery
This presentation focuses on the specific advantages of tubal surgery as compared to assisted reproductive techniques (ART).
Tubal surgery is a valid option in selected cases.
This selection is only possible through endoscopy and a precise knowledge of lesions is necessary. Three kinds of lesions have to be precisely known: pelvic adhesions and tubal lesions, either distal or proximal.
Nowadays, a special focus has to be made on subtle tubal lesions which were underestimated until recently.
Diagnosis and patient selection is a key factor and it is best achieved through transvaginal endoscopy such as fertiloscopy.
Even if today laparoscopy is the gold standard to treat tubal abnormalities, the principles of microsurgery which were defined a long time ago have to be strictly applied if one wants to get a pregnancy rate equivalent or superior to what is expected with in vitro fertilization (IVF).
Lecture
4 years ago
1889 views
78 likes
0 comments
16:07
Principles of tubal surgery
This presentation focuses on the specific advantages of tubal surgery as compared to assisted reproductive techniques (ART).
Tubal surgery is a valid option in selected cases.
This selection is only possible through endoscopy and a precise knowledge of lesions is necessary. Three kinds of lesions have to be precisely known: pelvic adhesions and tubal lesions, either distal or proximal.
Nowadays, a special focus has to be made on subtle tubal lesions which were underestimated until recently.
Diagnosis and patient selection is a key factor and it is best achieved through transvaginal endoscopy such as fertiloscopy.
Even if today laparoscopy is the gold standard to treat tubal abnormalities, the principles of microsurgery which were defined a long time ago have to be strictly applied if one wants to get a pregnancy rate equivalent or superior to what is expected with in vitro fertilization (IVF).
Fertility enhancing surgery
Reproductive surgery does not solely include tubal surgery, but also uterine surgery (surgery for malformations and myomas) and treatment for endometriosis. In tubal surgery, distal lesions can either be classified as phimosis (partial obstruction) or hydrosalpinx (complete obstruction). Phimosis requires fimbrioplasty; hydrosalpinx needs a neosalpingostomy. Proximal lesions may be functional (spasm, mucosal plugs) or organic (tubal clips, SIN, PID) which need resection and anastomosis. Tubal surgery does not rival with IVF but it is a complementary tool that may be used in selected cases.

To achieve adequate selection of cases suitable for tubal surgery, it is mandatory to accurately evaluate the uterine cavity, the tubal patency, the tubo-peritoneal environment (adhesions) as well as the tubal mucosa.
Non-invasive tests (hysterosalpingography, hysterosonography) do not permit to give a precise analysis of the lesions. Endoscopy is the only way to solve this problem. Fertiloscopy allows an exploration of the pelvis and salpingoscopy allows for an adequate and simple evaluation of the mucosal tube (easier than laparoscopy).

In case of normal salpingoscopy with abnormal fertiloscopy, surgery is recommended. In other cases, the recommended treatments are intrauterine insemination (IUI) or in vitro fertilization (IVF). In case of surgery, it is necessary to apply microsurgical principles: proper magnification, sufficient light, respect of tube (no touch technique), meticulous hemostasis (bipolar), avoidance of peritoneal desiccation, acute ovaro-salpingolysis, use of microsurgical instrumentation and microsuture, prevention of adhesions. When all of these criteria are respected, good results are obtained in terms of pregnancy rate.
Lecture
7 years ago
1353 views
23 likes
0 comments
22:49
Fertility enhancing surgery
Reproductive surgery does not solely include tubal surgery, but also uterine surgery (surgery for malformations and myomas) and treatment for endometriosis. In tubal surgery, distal lesions can either be classified as phimosis (partial obstruction) or hydrosalpinx (complete obstruction). Phimosis requires fimbrioplasty; hydrosalpinx needs a neosalpingostomy. Proximal lesions may be functional (spasm, mucosal plugs) or organic (tubal clips, SIN, PID) which need resection and anastomosis. Tubal surgery does not rival with IVF but it is a complementary tool that may be used in selected cases.

To achieve adequate selection of cases suitable for tubal surgery, it is mandatory to accurately evaluate the uterine cavity, the tubal patency, the tubo-peritoneal environment (adhesions) as well as the tubal mucosa.
Non-invasive tests (hysterosalpingography, hysterosonography) do not permit to give a precise analysis of the lesions. Endoscopy is the only way to solve this problem. Fertiloscopy allows an exploration of the pelvis and salpingoscopy allows for an adequate and simple evaluation of the mucosal tube (easier than laparoscopy).

In case of normal salpingoscopy with abnormal fertiloscopy, surgery is recommended. In other cases, the recommended treatments are intrauterine insemination (IUI) or in vitro fertilization (IVF). In case of surgery, it is necessary to apply microsurgical principles: proper magnification, sufficient light, respect of tube (no touch technique), meticulous hemostasis (bipolar), avoidance of peritoneal desiccation, acute ovaro-salpingolysis, use of microsurgical instrumentation and microsuture, prevention of adhesions. When all of these criteria are respected, good results are obtained in terms of pregnancy rate.