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#1:A double-headed operating microscope with both
surgeons focusing on the intra-abdominal pelvic contents is shown.
Microsurgery of the Fallopian tube requires magnification to this
level. Special eyeglasses and loupes are also helpful in this technique. |
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| #2:
After the abdomen is entered, peritubular adhesions are totally excised,
not lysed, with a microneedle cautery or fine microscissors. The uterus
is elevated into an ideal operative position by packing off the cul-de-sac
with wet gauze. |
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| #3:
The proximal end of the scarred, distal segment of Fallopian tube
is transected. A fine probe is inserted through the fimbriae and passed
through the open Fallopian tube. A notch in the probe has been designed
to accept a 2-0 Prolene or nylon suture. |
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| #4:
The 2-0 Prolene suture is pulled through the distal segment of the
Fallopian tube. |
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| #5:
The proximal segment of the tube is picked up and transected with
microscissors. |
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| #6:
The lower uterine segment is occluded with a Buxton clamp, and indigo
carmine dye is injected via a 21-gauge spinal neddle through the fundus
into the endmetrial cavity. Observation of spill from the stump indicates
patency of thecornual portion of the tube. |
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| #7:
A 2-0 suture is threaded through the proximal stump of Fallopian tube
into the endometrial cavity where it is allowed to coil. |
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| #8:
A similar procedure is performed on the opposite tube. |
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| #9:
The mesosalpinx of the Fallopian tubes is anasomosed with interrupted
8-0 Dexon suture via the microtechnique. |
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| #10:
After the mesosalpinx has been closed, the first layer of 8-0 Vicryl
suture is placed in a north, south, east, and west position. Care
is taken to place the microsuture in the submucosa layer of the tube
and avoid the tube mucosa when possible. |
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| #11:
Approximately 4 or 5 of these sutures are placed until the tube is
completely closed. |
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| #12:
A second layer of 8-0 Dexon suture is placed through the serosa and
outer portion of the muscle of the Fallopian tube. When tied, the
tube is anastomosed in such a manner that and indigo carmine solution
injected into the fundus will flow through the Fallopian tube. The
same procedure is carried out on the opposite side. |
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| #13:
In this sagittal section of the pelvis after completion of surgery, the pelvis is
filled with Hiscon (low-molecular-weight dextran) to reduce adhesion formation
following microsurgery by creating intra-abdominal ascites, which keeps the various
tissue surfaces separated until mesothelialization is complete. R indictes the rectum. |
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