Gynecologists Practcing Laparoscopic Tubal Recanalization Surgery on the Live Tissue Demonstration By Dr. J. s. Chowhan.

Nov 13, 2014 11:34 pm     Event Hits:3926     A⁺ | a^-

Event Date: Thu - 13 Nov, 2014

Event Time: 9:30 am

Location: World Laparoscopy Hospital, Gurgaon

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Institute: WLH

 In appropriate cases, anastomosis of the mid portion of the fallopian tube holds the greatest promise of success. The anastomosis can be isthmic-ampullary or ampullary-ampullary. .. Portions of occluded tube (in 2-mm sections) are repeatedly resected, first proximally and then distally, until the tubal lumen is identified in the proximal and distal stumps. Patency of the stumps is confirmed with retrograde chromotubation (proximal stump) and by threading a piece of thin suture from the fimbrial end toward the area of anastomosis (distal stump).

An anchoring suture is placed in the proximal and distal mesosalpinx to bring the 2 portions of the tube being anastomosed in proximity. Four interrupted sutures are placed at the 12-, 3-, 6-, and 9-o'clock positions, parallel to the axis of the tube, first within the muscularis and subsequently on the serosa, to bring together the proximal and distal portions of the tube.

Strict adherence to the principles of microsurgery improves the results of tubal recanalisation.  The use of crushing instruments, such as clamps and traumatic graspers, should be minimized to prevent tissue ischemia. All instruments must be fine and atraumatic, and only fine microsutures (eg, 8-0, 10-0) with tapered needles should be used on the fallopian tubes.

The drying of peritoneal and serosal surfaces is prevented with the use of continuous irrigation with warm isotonic fluid (eg, Ringer lactate solution). Minimal handling of the tissues decreases inflammation and adhesion formation. Postoperative adhesions can be decreased with the use of adhesion prevention barriers, such as oxidized regenerated cellulose .

Any suggestion of pelvic infection in the postoperative period requires aggressive antibiotic treatment because infection can result in adhesion formation and reocclusion of the fallopian tubes. Traditionally, pelvic rest (ie, no intercourse, nothing intravaginally) has been recommended during the first postoperative month in an effort to protect the reproductive organs during the healing period

Perform a hysterosalpingogram 3 months after tubal reconstruction. If the tube(s) is patent, the patient is allowed 1 year to achieve pregnancy before further evaluation and treatment is warranted.

When indicated, manage other correctible infertility factors during the first year following surgery. For example, treat oligo-ovulatory women with ovulation induction to improve the chance of pregnancy. Perform intrauterine insemination in women with cervical infertility and to treat mild-to-moderate oligospermia.

Women who have undergone tubal reconstruction are at a higher risk of ectopic pregnancy. Early evaluation of a pregnancy is critical to determine the site of implantation. Ectopic pregnancies identified early are small and can be managed more safely and easily. Women should be advised to contact their doctor within the first 2 weeks of a missed period. A vaginal ultrasound at the sixth week of gestation should identify an intrauterine sac, if present. If not present, the ectopic pregnancy should be managed medically or surgically as indicatedIf the postoperative hysterosalpingogram demonstrates bilateral tubal occlusion, refer the patient for IVF. The fallopian tubes are so delicate that repeated surgeries generally worsen the chances of success

Most pregnancies following tubal reconstructive surgery occur within a year of the procedure. The length of the tube following reconstructive surgery is directly correlated to success in terms of subsequent pregnancy. The prognosis of the surgical repair of hydrosalpinx with a diameter greater than 3 cm is very poor. The amount of pelvic adhesions and damage at the time of surgery is inversely correlated to the success of tubal reconstruction.

World Laparoscopy Hospital: A Hub of Contemporary Learning with Daily 8-Hour Hands-On Laparoscopic Training

In the realm of medical education and training, there are institutions that stand out as pioneers, constantly pushing the boundaries of what is possible. One such institution is the World Laparoscopy Hospital, where a contemporary event unfolds every day, featuring a remarkable 8-hour hands-on laparoscopic training program.

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At the heart of the World Laparoscopy Hospital's mission is the commitment to train the next generation of surgeons and medical professionals in the art and science of Minimal Access Surgery. What makes this institution truly exceptional is its daily 8-hour hands-on laparoscopic training program.

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Laparoscopic surgery, often referred to as minimally invasive surgery, has revolutionized the field of surgery in recent decades. Instead of large incisions, this technique involves making tiny keyhole-like openings through which a camera and surgical instruments are inserted. This results in significantly reduced patient trauma, shorter recovery times, and less post-operative pain.

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Impact Beyond the Classroom

The impact of the daily 8-hour hands-on laparoscopic training at World Laparoscopy Hospital extends far beyond the classroom. Graduates of this program return to their respective countries armed with advanced skills, contributing to the global dissemination of minimally invasive surgical techniques. Patients around the world benefit from the reduced invasiveness, faster recoveries, and improved outcomes that these skilled professionals bring to their practice.

In conclusion, World Laparoscopy Hospital's commitment to daily 8-hour hands-on laparoscopic training is a testament to its dedication to excellence in medical education. By offering a world-class learning environment and fostering a culture of innovation, this institution is shaping the future of surgery, one trainee at a time. It is not just an institution; it is a beacon of hope for patients and a driving force in advancing the field of surgery.