Tubal Reversal Blog ‘tubal reversal surgeon’

By Lisa D. Hourmouzis, RN
Tubal Reversal Nurse

It’s 7:30 am at Chapel Hill Surgical Center. In a moment of solitude, Dr. Gary Berger meticulously scrubs for the first surgery of the day. As he stands there quietly, I can’t help to wonder about the story behind the man in the surgical mask.

How did he become the surgeon he is today? What drives him to succeed?

These questions led to the following sit down with America’s leading tubal reversal surgeon, Dr. Gary Berger:

When did you decide to go into obstetrics and gynecology?
GB – When I was beginning my fourth year of medical school, during the time when we had to decide what direction we were going to go in, I felt like I wasn’t really secure enough in my basic medical foundation to want to jump into a specialty. So, I made the decision I would take a year of internship in internal medicine. But I had already made the decision that year to start my OB/GYN residency after the internship in medicine.

What led you to Duke?
GB – I was always a very hard worker. I guess I believed in the adage, “No pain, no gain.” So, I picked the hardest program in the US which was the medical internship at Duke University Medical Center. They had that reputation at the time. You were on-call five nights out of seven, and it was a very grueling program. But I thought I needed that to feel like I had a basic medical education before I proceeded.

Did anyone influence your decision to enter OB/GYN?
GB – I had been thinking about going into obstetrics and gynecology, and it just so happened that during that time we had a visit from Dr. Carl Tyler from the Centers for Disease Control. He was looking to recruit physicians into the EIS program, the Epidemic Intelligence Service. He came to the University of Rochester where I attended medical school and made contact with one of the pediatric professors there. I remember being on my pediatric rotation at that time.

Unbeknown to me, my pediatrics  professor had been an EIS officer; he also taught the courses in epidemiology and statistics, which I loved. Most of the other medical students weren’t so interested in them. Because I had done so well in those courses, he recommended that Dr. Tyler interview me. That was definitely a turning point in my life.

I was offered the opportunity to be in the U.S. Public Health Service at the CDC, but Dr. Tyler needed me to complete one year of my OB/GYN residency before I could join the program. That made my decision. I immediately started looking for residencies in OB/GYN.  And as it turned out, that two-year period was probably one of the most influential periods in my life. It was an absolute amazing experience.

What did you like most about obstetrics and gynecology?
GB – The thing I liked about obstetrics and gynecology was the obstetrics. I really did not think I would ever have an interest in performing surgery. In medical school, my surgical rotation was one of my least favorites.

What changed your view about surgery?
GB – During my third and fourth year of my OB/GYN residency, I had the good fortune of working closely with Dr. Jerry Hulka, the inventor of the Hulka clip. He made a big impression on me. His interests, aside from developing this technique in sterilization, were laparoscopic surgery and tubal surgery. So, it was during that time I became interested in tubal surgery; and what really solidified it was when I had the chance to see microsurgery performed. I knew at that point, that’s what I wanted to do.

Why did you decide to focus on tubal reversal surgery?
GB – My ideal was always to be able to do this surgery. I’ve done infertility treatment, IVF. I’ve done almost every type of GYN operation there is, with the exception of cancer surgery, but tubal microsurgery was always my special love. Fortunately, that’s where I am at this point.

What drives you?
GB – I think it’s a desire to be successful at whatever I do. If I’m doing tubal surgery, I want to be the best at doing tubal surgery. I want to know the most about it, have done the most and not just have the most experience, but intellectually, collected the most information. To me, that’s enjoyable because then I feel like it’s something that I’ve mastered. And of course, I like being able to help the couples that come here. I really feel that we can help most people. I know that  people are better off coming here than taking any other alternative that they have, in terms of having tubal reversal surgery.

What do you enjoy most about tubal reversal surgery?
GB – I like the challenge, the meticulousness about it. And I like being able to operate on patients and see them be comfortable and safe, and not dealing with complications.

I have a very idealistic view of things. If there’s a better way to do something, let’s find it and do it that way. I just think that’s a good way to practice medicine. But it’s not just about me personally; it has to do with everyone on our staff  who is involved in it.

Where do you hope to see tubal reversal surgery in the future?
GB – I don’t know if the pendulum will ever swing back to tubal reversal, it was there when I started 30 years ago. It was the new, exciting thing. And then IVF became the new and exciting thing.

Tubal surgery is quite different. I don’t think tubal surgery will ever suddenly become widely used or widely taught, but I think there is clearly a place for it. I like the fact that I’m training another doctor. And maybe in the future, one thing we might consider is becoming a training center where we could take physicians who are already at an advanced level like Dr. Monteith, and help them be able to do this type of surgery with expertise.

Tubal reversal helps a lot of patients, and there definitely should be the option for doctors to have additional education in it so that doctors don’t automatically send their patients into IVF programs when a simple tubal operation could be the solution.

Do you have a philosophy in your professional life?
GB – There’s an expression that I heard when I was in medical school, the quote was, “the secret in caring for the patient, is in caring for the patient.” And part of my philosophy is that I want to provide the exact type of medical care that I would want for myself, no less.

If I have to have a doctor, I want somebody who knows what they’re doing, is educated and a decent and kind person. Technically an expert, as knowledgeable about it as anyone, or more so than anybody else in the world. That’s the kind of doctor I would want for myself. Someone who will really take care of me if I have a problem and won’t brush it off or be too busy because it’s inconvenient for them. That’s the same thing that I want for my patients.

To learn more about Dr. Berger and Chapel Hill Tubal Reversal Center, call 919.968.4656 or contact one of our tubal reversal professionals today.

Submitted by Dr. James Split
Anesthesiologist
Chapel Hill Tubal Reversal Center

At Chapel Hill Tubal Reversal Center, we use general anesthesia for our tubal reversal surgeries. You will be completely asleep through your operation. When under general anesthesia, you will be totally unconscious and will not be able to feel any pain. In addition to the general anesthetic, your tubal reversal surgeon will place local anesthetic into the skin and deeper structures that are operated on to help you be as comfortable as possible when you wake up.

You will have an IV started after you arrive at the surgical center on the morning of your tubal reversal procedure. After you arrive in the operating room, we will give you an intravenous sedative similar to Valium to help you relax prior to going to sleep. We will take a blood pressure reading and then ask you to take several deep breaths of oxygen through a loosely applied face mask. We will put a sedative medication into your IV line that will make you fall asleep very quickly, usually in 10 to 20 seconds. We will keep you asleep during your surgery by having you breathe an anesthetic gas. During your operation, you will be given additional IV medications to prevent post-operative nausea and vomiting, and to minimize pain when you awaken.

We usually place a soft airway in your mouth after you are asleep. This airway is positioned behind your tongue to keep your airway open. This allows us to be sure you always have a safe open passageway for oxygen to enter your lungs. This airway goes into your mouth after you are asleep and is removed when you awaken. Most patients do not remember having a soft airway in their mouth, but some patients will have a scratchy or sore throat for 12 to 24 hours after surgery.

The anesthesiologist or nurse anesthetist will always remain with you while you are asleep. Throughout your tubal reversal procedure, we will monitor your blood pressure, heart rate, temperature and oxygen concentration in your bloodstream. You will awaken quickly after your surgery. Most patients are able to move themselves off the operating room table onto the stretcher to be taken into the recovery room.

Sometimes patients ask if they can have conduction anesthesia such as an epidural. We do not use epidural as outpatient anesthesia because of the risks involved. The method of general anesthesia that we use is safer than conduction anesthesia in the outpatient setting and less likely to cause a complication requiring hospitalization.

Dr. Gary Berger is leading the way in the specialty of tubal ligation reversal. Performing over 7,000 tubal reversals, Dr. Berger developed and refined the only one-hour, outpatient tubal reversal surgery using microsurgical techniques.

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Tubal Anastomosis at the Uterine Cornua

Tubouterine anastomosis is a tubal reversal procedure that is intermediate between tubotubal anastomosis and tubouterine implantation. It is also called cornual anastomosis because the tube is joined to the cornual area of the uterus with this operation. The cornu is the area where the fallopian tube normally emerges from the the uterus.

When Is Tubouterine Anastomosis Performed?

Tubouterine anastomosis is performed when there is a healthy tubal segment near the ovary, but no segment remains attached to the uterus, following a tubal ligation procedure. It is also performed when a tubal segment attached to the uterus is scarred and has no open lumen.

An incision is made into the uterus at the cornu to find the opening of the fallopian tube tube as it passes through the uterine muscle. If an opening is found, the tubal segment that remains is rejoined to the uterus at this site.

Case Histories

The topic of tubouterine anastomosis is a timely one. During the past week, 2 patients undergoing tubal reversal surgery at Chapel Hill Tubal Reversal Center required this operative procedure. In one case, each fallopian tube had been coagulated or burned next to the uterine cornu, leaving no segment attached to the uterus. The other patient had developed the condition known as salpingitis isthmica nodosa in the portion of the fallopian tube between the uterus and the a Falope ring. In both cases, tubal reversal was able to performed with the technique of tubouterine anastomosis.

Dr. Berger’s Comment

Frequently, patients have been informed by doctors who are not specialists in tubal ligation reversal that their fallopian tubes cannot be repaired after a tubal ligation. This is especially true when the proximal segments of the fallopian tubes are missing or diseased. But there are a variety of surgical techniques that can be used during tubal reversal surgery by a doctor who is an experienced tubal reversal surgeon. This is one of the advantages patients have when they come to Chapel Hill Tubal Reversal Center for their tubal reversal procedures.