Task Analysis of Laparoscopic Fallopian Tube Recanalization Surgery
Dr. Manju Sree. D.MAS (May 2019)


Indications:

 Desire for fertility
 Normal Semen Analysis
 Female Age less than 39 years
 Tubal occlusion using modified Pomeroy's, Fallope rings, Filshie clip
 HSG to assess remnant proximal isthmic portion of the fallopian tube

Attention to detail in:

 Respect delicate nature of the tissue
 Minimize the use of electrocautery
 Irrigate abdominal cavity with normal saline to minimize drying/adhesion

Procedural Tasks:

1. Patient in Lithotomy position under general anesthesia
2. Empty urinary bladder
3. Check Veress needle spring action and patency
4. Stab incision in the inferior crease of umbilicus
5. Hold Veress needle like a dart in the dominant hand
6. Lift suprapubic part of abdominal wall with the left hand
7. Insert Veress needle in the created stab incision
8. Perform saline test: infiltration / aspiration / hanging drop
9. Check quadromanometry for intraperitoneal placement of Veress needle
10. Check Insufflator preset pressure and volume settings, the Flow rate of 1 Litre per minute,  The maximum pressure to 15 mm
11. Start insufflation of Co2 at 1 liter per minute
12. Check uniform distension of abdomen/obliteration of liver dullness
13. Once the pressure of 15 mm Hg achieved, remove Veress needle
14.Extend the incision to the size of the cannula impression
15.Introduce 10mm port holding the port like a piston
16. Do a diagnostic laparoscopy, with special attention to fallopian tubes
17.Insert uterine manipulator to aid ease of suturing the fallopian tubes
18.Secondary and tertiary port placement
 based on the baseball diamond principle
19. Ipsilateral port placement may be desired
20.Dissecting scissors in dominant hand/ Maryland forceps in the other hand
21.Excise the occluded area with an agent of occlusion
22.Freshen up the ends of the fallopian tubes to be anastomosed
23.Ensure hemostasis
24.Approximate the mesosalpinx using interrupted 3-0 vicryl sutures
25. The freshened edges of the fallopian tubes are approximated
26.Preferred suture 4-0 vicryl with cutting edge needle
27. Seromuscular sutures are placed at 2/6/10 'O clock positions
28. Remember to complete both fallopian tubes
29. Patency may be checked using normal saline
30. Check hemostasis
31. Remove all ports under the vision
32.Close port sites