Microsurgical Tubal Anastomosis
& Tubal Implantation

How tubal reversal is performed

Tubal ligation reversal involves microsurgical techniques to open and reconnect the fallopian tube segments that remain after a tubal ligation procedure.

Usually there are two remaining fallopian tube segments – the proximal tubal segment that emerges from the uterus and the distal tubal segment that ends with the fimbria next to the ovary.

The procedure that connects these separated parts of the fallopian tube is called microsurgical tubotubal anastomosis, or tubal anastomosis for short.

Other terms used to describe this procedure are:

• microsurgical tubal reanastomosis
• microsurgical tubal reversal
• microsurgical tubal repair

Microsurgical tubal anastomosis

After opening the blocked ends of the remaining tubal segments, a narrow flexible stent is gently threaded through their inner cavities or lumens into the uterine cavity. This ensures that the fallopian tube is open from the uterine cavity to its fimbrial end. The newly created tubal openings are then drawn next to each other by placing a retention suture in the connective tissue that lies beneath the fallopian tubes. The retention suture avoids the likelihood of the tubal segments subsequently pulling apart.

Microsurgical sutures are used to precisely align the muscular portion (muscularis) and outer layer (serosa), while avoiding the inner layer (mucosa), of the fallopian tube. The tubal stent is then gently withdrawn from the fimbrial end of the tube.

Microsurgical tubal implantation

In some cases, a tubal ligation procedure leaves only the distal portion of the fallopian tube and no proximal tubal opening into the uterus. This may occur when monopolar tubal coagulation has been applied to the isthmic segment of the fallopian tube as it emerges from the uterus. In this situation, a new opening can be created through the uterine muscle and the remaining tubal segment inserted into the uterine cavity. Another situation where this procedure is useful is when sterilization has been performed with the Essure technique, in which case the implant is removed after the uterine incision has been made.

This microsurgical procedure is called tubal implantation, tubouterine implantation, or uterotubal implantation. Dr. Monteith performs microsurgical tubal implantation if microsurgical tubal anastomosis is not possible due to the absence of a proximal tubal segment and interstitial tubal lumen (see fallopian tube anatomy).