Tubal Reversal Blog ‘diagnostic laparoscopy’

This is the fifth article of a series dedicated to women considering alternatives for pregnancy and tubal ligation reversal after the age of 40.  The previous article provided an overview of the benefits of tubal ligation reversal at Chapel Hill Tubal Reversal Center for women in their forties. This article focuses on the surgical and early pregnancy risks for older women having their ‘tubes untied’.

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Why Some Patients Choose To Have Screening Laparoscopy

Tubal ligation procedures vary in the severity of injury occurring to the fallopian tubes. Although most tubal ligations are reversible, there are some cases where tubal reversal is not possible. If the operative report from your tubal ligation indicates there may be a problem in repairing the remaining tubal segments, or if you cannot get a copy of your operative report, you may be interested in the screening laparoscopy option offered at Chapel Hill Tubal Reversal Center.

With this option, your surgery begins with diagnostic laparoscopy to examine your fallopian tubes. If tubal repair is possible, tubal reversal is performed immediately while you are under anesthesia. That way you do not have to undergo anesthesia and surgery on two separate occasions.

If tubal reversal is not possible, the operation is concluded with just the diagnostic laparoscopy. There is an additional charge of $1000 to add the screening laparoscopy, but with this option you will receive almost half of the total surgery fee in refund should tubal repair not be performed. The “laparoscopy package” is excellent insurance in situations when the method of tubal ligation is unknown.

Screening laparoscopy is available to patients with a Body Mass Index (BMI) under 30 who are interested in more assurance regarding the outcome of the reversal surgery. It is recommended – but not required – in cases where the amount of tube remaining is questionable, such as after monopolar tubal coagulation at multiple sites along the tube.

If you have questions about the laparoscopy option, you can discuss them with Dr. Berger and the Tubal Reversal nurses during your preoperative consultation.

Tubal Ligation Operations Vary

Tubal ligation operations vary in the amount of damage they cause to the fallopian tubes. Tubal coagulation (cauterization) tends to damage more of the tube than tubal ligation and resection or tubal clips/rings. Burning or cauterizing the fallopian tubes with a monopolar coagulator is more destructive than with a bipolar coagulator. With either type of coagulator, the more times the tube is burned, the greater the amount of damage that occurs.

How Much Fallopian Tube Remains After a Tubal Ligation?

The remaining amount and condition of the fallopian tubes after tubal ligation procedures varies a great deal. A patient’s tubal ligation operative report will give an indication about the remaining tubal segments that can be repaired by a tubal reversal procedure. When available, Dr. Berger always reviews the operative reports that are sent by patients to estimate the likely outcome from a tubal reversal operation.

In most cases, the tubal ligation operative report (and a pathology report if available) will help to determine if tubal reversal is possible. Until the time of surgery, the actual condition of the fallopian tubes remains unknown. This is partly because doctors differ in how they perform tubal ligation operations. With tubal coagulation procedures, for example, the coagulator can be used at different power settings and applied for varying lengths of time to the fallopian tubes. These details usually are not specified in an operative report.

Examining the Fallopian Tubes by Laparoscopy

Laparoscopy is a surgical procedure that permits viewing the fallopian tubes through a narrow telescope placed through a small incision below the belly button into the abdominal cavity. Laparoscopy can be performed for patients who want to be assured that tubal reversal is possible.

Laparoscopy is recommended in cases where the amount of tube remaining is questionable, such as after monopolar coagulation of multiple sites along the fallopian tube.

Dr. Berger performs laparoscopy under anesthesia and proceeds directly to tubal reversal, if examination shows the tubes are repairable. The patient is under anesthesia only one time. For safety reasons, screening laparoscopy is offered only to patients with a body mass index (BMI) of less than 30.

Screening Laparoscopy Cost

The additional charge for laparoscopy is $1000. If tubal reversal is not possible, the operation will end and you will receive a refund of close to 50% of the total surgery fee. The screening laparoscopy option is similar to an insurance policy. You purchase it and hope you never need it, but it is certainly nice if you do. Most patients do not elect to have the laparoscopic examination because of its additional cost and the knowledge that Dr. Berger can repair the fallopian tubes in 98% of cases, regardless of the method of tubal ligation.