Laparoscopic Tubal Recanalization

Laparoscopic Tubal Recanalization

Dr. Pradeep GargAssistant Professor

Dept. of Obst. & GynaeAll India Institute of Medical Sciences, New Delhi

Email:pkgarg_in2004@yahoo.com

Laparoscopic microsurgery is a new discipline that synergizes the

potential of classical microsurgery and laparoscopy

Introduction

Dr. Pradeep Garg, Assistant Professor, Obs. & Gynae, All India Institute of Medical Sciences, New Delhi

Advantages of Laparoscopic Tubal Recanalization

• All microsurgical principles are well maintained like

magnification, tissue handling, haemostasis & lavage

• Avoids laparotomy & tissue trauma associated with packing &

retractors

• Minimal tissue handling & trauma

• Adhesions are minimal

• Cosmetically far better

• Faster recovery

Dr. Pradeep Garg, Assistant Professor, Obs. & Gynae, All India Institute of Medical Sciences, New Delhi

Indications of Tubal Anastomosis

• Reversal of tubal sterilization procedure

• Mid-tubal block secondary to various pathology

• Tubal occlusion secondary to ectopic pregnancy treatment

• Salpingitis isthmica nodosa

• Failed tubal cannulation for proximal tubal block

Dr. Pradeep Garg, Assistant Professor, Obs. & Gynae, All India Institute of Medical Sciences, New Delhi

Contraindications

• Aged 40 years or older• Decreased ovarian reserve or ovarian failure• Extensive tubal damage• Hydrosalpinx with a diameter of more than 3 cm• Inadequate proximal or distal tubal segment for reanastomosis• Projected tubal length of less than 3 cm after the reconstruction

procedure• Extensive pelvic/peritubal adhesions• Any contraindication to pregnancy or surgery• Severe male factor infertility or male sterility

Dr. Pradeep Garg, Assistant Professor, Obs. & Gynae, All India Institute of Medical Sciences, New Delhi

Instrumentation

• High resolution three-chip camera

• Good light source

• High resolution monitor

• Microsurgical hand instruments

Dr. Pradeep Garg, Assistant Professor, Obs. & Gynae, All India Institute of Medical Sciences, New Delhi

Chromopertubator and injection needle

Dr. Pradeep Garg, Assistant Professor, Obs. & Gynae, All India Institute of Medical Sciences, New Delhi

Suction irrigation cannula and curve monopolar hook

Dr. Pradeep Garg, Assistant Professor, Obs. & Gynae, All India Institute of Medical Sciences, New Delhi

Microneedle holder and micrograsping forceps

Dr. Pradeep Garg, Assistant Professor, Obs. & Gynae, All India Institute of Medical Sciences, New Delhi

Ultramicro scissors

Dr. Pradeep Garg, Assistant Professor, Obs. & Gynae, All India Institute of Medical Sciences, New Delhi

Dr. Pradeep Garg, Assistant Professor, Obs. & Gynae, All India Institute of Medical Sciences, New Delhi

3.5 mm microtrocars with automatic valve

Movie

To see videos on laparoscopic gynae surgeries please logon to

www .youtube.com and type Pradeep aiims

Conclusion

• Laparoscopic microsurgery offers all the benefits of traditional

microsurgery coupled with the inherent advantages of laparoscopy

Dr. Pradeep Garg, Assistant Professor, Obs. & Gynae, All India Institute of Medical Sciences, New Delhi

For queries mail me at

pkgarg_in2004@yahoo.com

•MBBS from SNMC Agra in1995•Post graduation in obs gynae from All India Institute of Medical Sciences in 1998•Three years of senior residency in obs and gynae from All India Institute of MedicalSciences in 2001

•Currently working as assistant prof. in All India Institute of Medical Sciences since 2002•Field of interest is gynae endoscopic surgery and infertility•Have many publications in national and international journals•Running endoscopic training centre ( Gynae Endo Training Centre AIIMS) at All IndiaInstitute of Medical Sciences since 2004 and trained more than 200 candidates fromIndia and abroad

•Conducted many laparoscopic workshops as operating faculty in India and abroad

Biodata Dr. Pradeep Garg