what can be done to reverse a laparoscopic tubal sterilization with bipolar cautery?

Answer 1

http://www.greenjournal.org/cgi/content/full/94/2/163

Answer 2

The patient, under general anaesthesia, was placed in Trendelenburg's position with her left arm along her side, her thighs abducted and slightly flexed. After adequate pneumoperitoneum was achieved with CO2 gas, the abdomino–pelvic cavity was systematically explored and the adnexa was inspected, searching for any contraindication to the procedure (Gomel, 1980Go; Dubuisson et al., 1995Go). Three 5.5 mm trocars (Surgiport; USSC, Elancourt, France) were inserted suprapubically; these were placed high, the two lateral ones being positioned outwardly with respect to the epigastric arteries, so as to allow for an approach to the Fallopian tube at right angles to its axis. During the procedure, fine atraumatic forceps and bipolar cautery were used for observance of microsurgery principles, with minimal trauma and careful haemostasis.

Stump preparation and end marking
This step was important because it is necessary to perform the suture in healthy tissues. When using Hulka clips, Li et al. (1996) showed that at a distance of 0.5 cm away from the ligated scar, numerous cilia of the epithelium were twisted and adhered, the shape of the epithelial cells was irregular, and many microvilli and cilia were even lost from the local epithelium (Li et al., 1996Go). The microvilli and cilia of the epithelium, however, were normal on the mucosa 1.0 cm from the ligated scar. This was therefore the best situation that we could hope to achieve. On the other hand, after electrocoagulation sterilization, Pomeroy technique (Kim et al., 1997Go) or Yoon rings (Rouzi et al., 1995Go), the significant tissue destruction caused by diffusion of the electrical energy or by the plastic device can ruin the effect of attempted reversal because of the large amount of excised tubal tissue required, which can be as much as 2 cm on each side.

The clip or the sterilized zone was caught in the jaw of the forceps, lifted up, and the section was performed with scissors perpendicular to the Fallopian tube, in such a way as to preserve the infratubal vascularization. Hysteroscopically guided backward catheterization of the proximal tubal stump and intubation of the prepared distal stump were then carried out with a Teflon catheter (Cook, Charenton, France) of 1 mm in diameter.