History of Tubal Reversal Surgery
Tubal Reversal Scholarly Publications
Early Experimental Studies in Animals
In 1969, David, Brackett and Garcia (1) reported using microsurgical techniques for uterotubal anastomosis after removing the uterotubal junction from one side in 25 rabbits. Among 11 (44%) of the animals that became pregnant, fewer implantations occurred on the operated side than on the unoperated side. This showed that the uterotubal junction has a role, but is not absolutely required, in transferring embryos from the fallopian tube into the uterus for implantation.
In 1974, Paterson and Wood (2) divided the isthmic segment of one fallopian tube and then performed tubal anastomosis in 10 rabbits. They removed the fallopian tube and ovary on the other side so that any pregnancies that followed could be attributed to the repaired fallopian tube. The pregnancy rate was 60%. These investigators suggested that tubal anastomosis could be applied successfully to humans for reversal of tubal sterilization.
Hulka and Ulberg (3) in 1975 were the first to perform a successful reversal of tubal sterilization under experimental conditions. Six weeks after applying Hulka clips to the isthmic portion of fallopian tubes in 8 pigs, they removed the clipped portion of tubes and performed tubal anastomosis using an absorbable, multifilament suture (6-0 Dexon). Six (75%) of the animals subsequently became pregnant.
In 1975 Winston (4) reported an experiment in rabbits in which the experimental variables were different suture materials and duration of tubal splinting. In one group of 25 rabbits, he removed a portion of the tubal isthmus or ampulla and then performed tubotubal anastomosis with a nonabsorbable, nonreactive, monofilament suture (10-0 nylon). Using microsurgical technique, Winston took special care to include only the 2 outer layers (muscularis and serosa) of the fallopian tube in the suture line, avoiding the inner tubal layer (endothelium). He stabilized the anastomotic sites with polyethylene splints that were removed before closure of the abdominal cavity. Twenty-three (92%) of the animals became pregnant. This was the highest pregnancy rate reported so far after tubal anastomosis in animal studies. When either 8-0 catgut was used as the suture material or the tubal splint was left in place for 1 week after surgery, the pregnancy rate dropped in half.
Winston’s results were subsequently corroborated using microsurgical tubal anastomosis with 11-0 nylon, intraoperative splinting, and avoiding mucosal trauma from suture in the reconstruction of rabbit oviducts six weeks after application of Falope rings. Eighteen (82%) of 22 rabbits became pregnant after two matings.
Comment
Experimental studies in animals demonstrated excellent pregnancy rates following reconstruction of the fallopian tube by tubal anastomosis. They provided the basis for tubal reversal surgery as a clinical treatment. The best results came using microsurgical techniques with non-reactive, monofilament suture material, intraoperative tubal splints, and avoiding the introduction of suture in the inner layer of the tube.
Dr. Berger uses these surgical techniques in his tubal reversal procedures. For a more complete description of the early history of tubal reversal surgery, read Dr. Berger’s book chapter, Reversal of Female Sterilization: An Evaluation of Results (5).
References
- David A, Brackett BG, Garcia CR: Effects of microsurgical removal of the rabbit uterotubal junction. Fertil Steril 20:250, 1969
- Hulka JF, Ulberg LC: Reversibility of clip sterilization. Fertil Steril 26:1132, 1975
- Paterson P, Wood C: The use of microsurgery in the reanastomosis of the rabbit fallopian tube. Fertil Steril 25:757, 1974
- Winston RML: Microsurgical reanastomosis of the rabbit oviduct and its functional and pathological sequelae. Br I Obstet Gynaecol 82 :513, 1975
- Berger GS: Reversal of female sterilization: An evaluation of results. In JM Phillips, editor, Microsurgery in Gynecology, Chapter 33. American Association of Gynecologic Laparoscopists, Downey, California, 238-243, 1977.
December 16th, 2007 at 5:06 pm
It amazing to see the history behind tubal reversal surgery. The amazing thing is that one year after the study of tubal reanastamosis in rabbits was being done, Dr. Berger went abroad to train in the field of tubal reversal surgery since there was not a program available in the United States. This should not only reassure patients of Dr. Berger’s skill but also to his commitment to tubal reversal surgery and his patients.
December 16th, 2007 at 7:04 pm
I know this information will be informative for potential patients. One of the most frequently asked questions I receive is whether the tubal splint damages the tube and whether or not Dr. Berger sews all three layers of the tube. This historical summary of tubal reversal surgery shows that the original surgeons performing tubal reversal surgery had the best results using the very techniques Dr. Berger uses and has perfected over 30 years: Microsurgical techniques using non-reactive suture, the use of a tubal splint, and suturing the outer two layers of the tube, while avoidng the inner layer.
This is excellent information for anyone considering tubal reveral surgery.
December 16th, 2007 at 9:01 pm
The doctor who I trained with in 1976 was Dr. Robert Winston whose studies I reviewed in this blog topic. I contacted Dr. Winston after reading about his experimental results and then went to work with him in Leuvan, Belgium and London, England. He taught me his techniques of tubal microsurgery that produced such excellent results. Over the years, I have made these surgical techniques applicable to the outpatient setting.
December 18th, 2007 at 3:47 pm
It should always be commended when a person devotes themselves to doing their work because it is their passion. When a person is giving so much of themselves to benefit others. To teach, to help, to give hope. Dr. Berger does this everyday!
December 18th, 2007 at 7:08 pm
Today was quite stressful and somewhat scary to me in a nervous type of way. So, that being said, I didn’t offer very much conversation… which is not normal for me by far! Being a freelance journalist and reporter for a long time (in the past), creating and devising plans around stories- then, not having anything to say was mind boggling! I just wanted to comment to the staff and Dr. Berger that today I was just out of sorts and out of my element completely. The procedure was simple enough, in which I’m sure they made it seem that way, but I cannot imagine the work that goes into it such as the amount of work that used to go into my writing(s). However, I was very impressed and thankful for the passion I saw within the demeanor of each person I encountered. Whether it was a nurse, the surgical techs, anethesiologists or Dr. Berger- I saw a committment and integrity that is rare in this day and time… and to that, I have faith in their research, their hard work/hours and dedication to making my personal experience easier and meaningful to me. Thank you. Chasity Martin