Abstract：
OBJECTIVE: To show the technique of reduced sutures in 3D laparoscopic tubal reanastomosis.
METHODS: Step-by-step demonstration of the procedure using video.
METHODS: Laparoscopic tubal sterilization reversal demands high precision and requires both skill and experience. Conventionally, 4 to 6 interrupted patterns using 6-0 to 8-0 absorbable sutures are used for laparoscopic tubal reanastomosis. We used fewer and larger sutures under a magnified 3D view to perform the procedure.
METHODS: We presented a case of a 42-year-old woman, gravida 3, para 3, who underwent tubal sterilization during Cesarean section 10 years ago. Preoperative hysterosalpingography (HSG) showed bilateral distal tubal occlusion. The procedure started with the subserosal injection of diluted vasopressin in both proximal and distal ends and in the mesosalpinx to facilitate dissection and hemostasis. After transection of tubal stump and removal of scar tissue, we used a 3 Fr ureteral catheter as the stent to facilitate suturing. Three interrupted 4-0 monocryl sutures were used for suturing both tubal mucosal and muscular layers at 6, 2, and 10 o\'clock sites. We performed bilateral ampullo-ampullary reanastomosis. The tubes were successfully reanastomosed, and patency was confirmed by chromotubation performed at the end of the procedure (Figure 1). The operation lasted for 71 minutes. The operative blood loss was less than 50 ml. Patent right fallopian tube was confirmed on postoperative HSG 1 month later. The patient had a successful pregnancy 8 months after the operation.
CONCLUSIONS: Our experience shows the feasibility of 3D laparoscopy for tubal reanastomosis using reduced sutures. The technique alleviates the damage to the fallopian tube. The operative time, hospital stay, and postoperative adhesions were significantly lower than the conventional method with a comparable success rate.
METHODS: Step-by-step demonstration of the procedure using video.
METHODS: Laparoscopic tubal sterilization reversal demands high precision and requires both skill and experience. Conventionally, 4 to 6 interrupted patterns using 6-0 to 8-0 absorbable sutures are used for laparoscopic tubal reanastomosis. We used fewer and larger sutures under a magnified 3D view to perform the procedure.
METHODS: We presented a case of a 42-year-old woman, gravida 3, para 3, who underwent tubal sterilization during Cesarean section 10 years ago. Preoperative hysterosalpingography (HSG) showed bilateral distal tubal occlusion. The procedure started with the subserosal injection of diluted vasopressin in both proximal and distal ends and in the mesosalpinx to facilitate dissection and hemostasis. After transection of tubal stump and removal of scar tissue, we used a 3 Fr ureteral catheter as the stent to facilitate suturing. Three interrupted 4-0 monocryl sutures were used for suturing both tubal mucosal and muscular layers at 6, 2, and 10 o\'clock sites. We performed bilateral ampullo-ampullary reanastomosis. The tubes were successfully reanastomosed, and patency was confirmed by chromotubation performed at the end of the procedure (Figure 1). The operation lasted for 71 minutes. The operative blood loss was less than 50 ml. Patent right fallopian tube was confirmed on postoperative HSG 1 month later. The patient had a successful pregnancy 8 months after the operation.
CONCLUSIONS: Our experience shows the feasibility of 3D laparoscopy for tubal reanastomosis using reduced sutures. The technique alleviates the damage to the fallopian tube. The operative time, hospital stay, and postoperative adhesions were significantly lower than the conventional method with a comparable success rate.
摘要：
目的：显示三维腹腔镜输卵管再吻合中的减少缝线技术。
方法：使用视频逐步演示该过程。
方法：腹腔镜输卵管反灭菌术要求高精度，需要技术和经验。传统上,使用6-0至8-0可吸收缝线的4至6个中断模式用于腹腔镜输卵管再吻合。我们在放大的3D视图下使用了更少和更大的缝线来执行手术。
方法：我们介绍了一个42岁女性的案例，gravida3，para3，10年前在剖宫产期间接受了输卵管绝育。术前子宫输卵管造影（HSG）显示双侧远端输卵管闭塞。该程序从浆膜下注射稀释的血管加压素开始，在近端和远端以及输卵管系膜中进行，以促进解剖和止血。在横切输卵管残端和去除瘢痕组织后，我们使用3Fr输尿管导管作为支架以促进缝合。在6、2和10个时钟部位使用了三个中断的4-0单锁骨缝合线缝合输卵管粘膜层和肌肉层。我们进行了双侧壶腹-壶腹吻合术。这些管成功地重新吻合,通过在手术结束时进行的染色观察证实了通畅(图1).手术持续了71分钟。手术失血量小于50ml。术后1个月HSG证实右输卵管未闭。患者在手术后8个月成功怀孕。
结论：我们的经验表明3D腹腔镜手术使用减少缝线进行输卵管再吻合的可行性。该技术减轻了对输卵管的损伤。手术时间,住院,术后粘连明显低于常规方法，成功率相当。
方法：使用视频逐步演示该过程。
方法：腹腔镜输卵管反灭菌术要求高精度，需要技术和经验。传统上,使用6-0至8-0可吸收缝线的4至6个中断模式用于腹腔镜输卵管再吻合。我们在放大的3D视图下使用了更少和更大的缝线来执行手术。
方法：我们介绍了一个42岁女性的案例，gravida3，para3，10年前在剖宫产期间接受了输卵管绝育。术前子宫输卵管造影（HSG）显示双侧远端输卵管闭塞。该程序从浆膜下注射稀释的血管加压素开始，在近端和远端以及输卵管系膜中进行，以促进解剖和止血。在横切输卵管残端和去除瘢痕组织后，我们使用3Fr输尿管导管作为支架以促进缝合。在6、2和10个时钟部位使用了三个中断的4-0单锁骨缝合线缝合输卵管粘膜层和肌肉层。我们进行了双侧壶腹-壶腹吻合术。这些管成功地重新吻合,通过在手术结束时进行的染色观察证实了通畅(图1).手术持续了71分钟。手术失血量小于50ml。术后1个月HSG证实右输卵管未闭。患者在手术后8个月成功怀孕。
结论：我们的经验表明3D腹腔镜手术使用减少缝线进行输卵管再吻合的可行性。该技术减轻了对输卵管的损伤。手术时间,住院,术后粘连明显低于常规方法，成功率相当。
