Current practice in tubal surgery and adhesion management: a review

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Presentation transcript:

Current practice in tubal surgery and adhesion management: a review A. Watrelot, G. Chauvin  Reproductive BioMedicine Online  Volume 23, Issue 1, Pages 53-62 (July 2011) DOI: 10.1016/j.rbmo.2011.03.018 Copyright © 2011 Reproductive Healthcare Ltd. Terms and Conditions

Figure 1 Distal lesions. Bottom right: the fimbria may still exist but with no communication with the ampulla, in this case it is a hydrosalpinx and not a phimosis. Reproductive BioMedicine Online 2011 23, 53-62DOI: (10.1016/j.rbmo.2011.03.018) Copyright © 2011 Reproductive Healthcare Ltd. Terms and Conditions

Figure 2 Principles of fertiloscopy: introduction of veres needle into the pouch of Douglas. Reproductive BioMedicine Online 2011 23, 53-62DOI: (10.1016/j.rbmo.2011.03.018) Copyright © 2011 Reproductive Healthcare Ltd. Terms and Conditions

Figure 3 Principles of fertiloscopy: telescope in the pouch of Douglas, allowing the examination of genital structures. Note the balloon, which prevents an inadvertent exit from the pouch of Douglas. Reproductive BioMedicine Online 2011 23, 53-62DOI: (10.1016/j.rbmo.2011.03.018) Copyright © 2011 Reproductive Healthcare Ltd. Terms and Conditions

Figure 4 A special variety of phimosis: the ‘bridge’ adhesions should be carefully searched for since this non-obstructive lesion may impair oocyte retrieval. Treatment consists of: (A) carefully dividing the bridge; and then (B) fixing the eversion with two micro-sutures. Reproductive BioMedicine Online 2011 23, 53-62DOI: (10.1016/j.rbmo.2011.03.018) Copyright © 2011 Reproductive Healthcare Ltd. Terms and Conditions

Figure 5 Typical aspect of phimosis. Reproductive BioMedicine Online 2011 23, 53-62DOI: (10.1016/j.rbmo.2011.03.018) Copyright © 2011 Reproductive Healthcare Ltd. Terms and Conditions

Figure 6 Hydrosalpinx filled with dye. Reproductive BioMedicine Online 2011 23, 53-62DOI: (10.1016/j.rbmo.2011.03.018) Copyright © 2011 Reproductive Healthcare Ltd. Terms and Conditions

Figure 7 Salpingoneostomy. (A) Opening of the tube on the site of the previous ostium. (B) Mucosal eversion by two gentle atraumatic forceps to create a new mucosal cuff. (C) Cuff salpingoneostomy. (D) Racket-form salpingoneostomy (fixation with fine sutures). The choice between the two eversion techniques depends on the thickness of the tubal wall. Cuff salpingoneostomy should be preferred when it is possible (Winston and Margara, 1991). Reproductive BioMedicine Online 2011 23, 53-62DOI: (10.1016/j.rbmo.2011.03.018) Copyright © 2011 Reproductive Healthcare Ltd. Terms and Conditions