Performing a tubal reanastomosis requires microsurgical techniques (see
Microsurgery), however, obtaining access to the fallopian tubes first requires a standard surgical procedure called a minilaparotomy. In a minilaparotomy, a side-to-side incision is performed in the middle of the lower abdomen (just below the pubic hair line), approximately 5-6 cm (2-2.5 inches) in length. The incision is carefully extended into the deep subcutaneous tissues until the pelvic cavity is entered and the pelvic organs (uterus, fallopian tubes, and ovaries) can be visualized. The uterus and fallopian tubes are next partially raised above the abdominal incision, providing the surgeons easy access to the fallopian tubes. The use of self-retaining retractors is avoided to minimize tissue damage. From this point on, microsurgical techniques are employed.
Since all tubal ligation procedures result in some degree of damage and scarring to the tube, the first step of microsurgical tubal reversal is to carefully remove the damaged portion of the tube, along with any materials which were used to block the tube during the ligation (sutures, clips, bands…). Great care is taken to avoid removing healthy portions of the tube and to preserve the final tubal length. After the damaged portion of the tube is removed, a proximal segment (originating from the uterus) and a distal segment (originating at the fimbriae adjacent to the ovary) remain, which require re-connection. The blocked end of each tubal segment is next carefully opened. A single retention suture is next placed just below the tubal segments in an area called the mesosalpinx, which aligns the two segments and ensures that the reanastomosis procedure will be tension free. Finally, the two open ended tubal segments are sutured to one another using small gauge microscopic sutures (see Microsurgery) placed in the middle muscular layer (muscularis) of each tube, avoiding both the outer layer (serosa) and inner layer (endosalpinx/mucosa) in order to minimize scar tissue formation on the outside and inside of the tube. A sterile dye injected into the uterus and out of the fallopian tubes confirms that the reanastomosis was successful by illustrating the spillage of dye from the tubal fimbriae.
