By rejoining the separated segments of the fallopian tube, tubal reversal can give women the chance to become pregnant again.
After opening the blocked ends of the remaining tubal segments, a variety of microsurgical techniques are utilized to recreate a functional tube.
The newly created tubal openings are drawn next to each other by placing sutures in the connective tissue that lies beneath the fallopian tubes (mesosalpinx).
Most surgeons try to avoid the use of stents which can damage the delicate cilia that line the tube and create the flow of fluid that is needed to push the egg and embryo into the uterus.
This can occur when any method of tubal ligation has been applied to the isthmic segment of the fallopian tube as it emerges from the uterus.
After fimbriectomy, if the remaining tubal segment is long enough, the end of the tube can be opened and 'new' fimbria can be created by a procedure called a neofimbrioplasty.
The size and location of the incision as well as the plastic surgery techniques used to close it make the thin scar nearly invisible after it has healed.
Failing to properly align the tubal segments, or damaging these delicate structures, can make the difference between a successful and an unsuccessful operation.
[3] Laparoscopic Tubal Reversal is a minimally-invasive surgical procedure (laparoscopy), using small, specially-designed instruments to repair and reconnect the fallopian tubes.
After general anesthesia has been administered, a 5mm (less than 3/8-inch) tube (trocar) is inserted inside the navel, and a special gas is pumped into the abdomen to create enough space to perform the operation safely and precisely.
Once the connection (anastomosis) is completed, a blue dye is injected through the cervix, traveling through the uterus and tubes, all the way to the abdomen.
Patients should wait two months prior to attempting pregnancy in order to give the tubes a chance to heal completely.
When performed by a trained laparoscopic tubal reversal surgeon, laparoscopic tubal reversal combines the success rates of micro-surgical techniques with the advantages of minimally-invasive surgery – namely faster recovery, better healing, less pain, fewer complications, and no large disfiguring scars.
Robotic tubal reversal surgery, when compared to abdominal tubal reversal surgery, had longer operative times (201 minutes vs 155 minutes), shorter hospital stays (4 hours compared to 34 hours), and quicker return to activities of daily living.
[7] Reversal of Essure sterilization requires the blocked isthmic portion of the tube be bypassed by tubouterine implantation.
During a tubouterine implantation procedure, the blocked portion of the fallopian tube containing the Essure sterilization device is surgically resected.
[8] Surgeons who published the first case report of successful Essure reversal subsequently published a larger cohort study of 70 patients who underwent outpatient tubouterine implantation to reverse Essure sterilization and 36% of patients reported pregnancy through natural conception.
[citation needed] Between 2009 and 2018, Monteith performed 469 outpatient tubouterine implantation procedures to reverse Essure sterilization.
Intraoperative risks observed were failure to complete the planned procedure (either Essure removal and tubal occlusion or Essure removal and bilateral tubouterine implantation) <1%, fracture of Essure devices during removal (approximately 10% risk with manual traction and < 1% with en bloc dissection), transfer to hospital <1%, referral to Emergency room or hospital within 24 hours of surgery <1%, bleeding requiring blood transfusion or hospitalization for operative complication 0%, anesthesia complication 0%, and death 0%.
All patients were advised to have a planned cesarean delivery before the onset of labor and the risk of uterine rupture was observed to be 4%.
[10] Hologic Corporation discontinued the procedure in March 2012, resolving ongoing litigation with Conceptus concerning patent infringement claims.
[12] These include the women's ages, methods of tubal ligation that they had performed, experience of the surgeon and techniques for repairing the tubes, length of follow-up after reversal surgery among other factors.