laparoscopic tubal ligation reversal surgery

baby lawnThe most minimally invasive technique for tubal ligation reversal is a laparoscopic approach. Laparoscopic tubal ligation reversal is the newest technique to “untie” tubes. Our experienced fertility surgeons, Drs. Bateman, Williams and Smith, are pleased to offer this technique that only a relatively small number of physicians are able to perform nationwide.  But we suggest most of our patients choose to have the mini-laparotomy approach with a microscope for the highest chance of success.

Laparoscopy is a minimally invasive surgical technique whereby the anesthetized patient has small incisions made in the abdomen and a camera mounted on a long lens is inserted through the base of the navel to project images on a video monitor. Laparoscopy is an outpatient procedure in nearly all instances. It is utilized in many aspects of gynecologic surgery and its usefulness grows yearly as more gynecologic surgeons apply laparoscopy to more and more types of surgery.

The major advantage to a laparoscopic approach is that the largest incision is only one centimeter in size, compared to about 6 cm incision (made on the lower abdomen just above the pubic bone) for the mini-laparotomy procedure. Laparoscopy for tubal reversal surgery requires 5 small incisions, 3 mm, 5mm or 10mm. All these incisions have merely a band-aid covering them when you are discharged home. Both surgical techniques (mini-laparotomy and laparoscopy) will almost always allow you to go home the same day but recovery from the laparoscopic approach is approximately 1 week whereas the mini-laparotomy approach requires 2 to 3 weeks of recovery.

As described in other parts of this Website, tubal reversal surgery by mini-laparotomy has been performed by our surgeons for more than 40 combined years. It uses a microscope and a very delicate technique to remove the scar tissue and reattach the fallopian tubes following tubal ligation.

The laparoscopic approach does not use a microscope but the lens of the camera is able to be placed right up against the surgery site allowing close inspection.  That being said, the microscope is superior because it magnifies the view dramatically improving the surgeon’s ability to offer the best repair.

Because the laparoscopic approach to tubal ligation reversal is relatively new technique there is a limited amount of experience worldwide. What research is available indicates that, although the laparoscopic approach does not use a microscope, the pregnancy rates of microscopic mini-laparotomy technique and laparoscopy are probably similar. Currently, there is no evidence from randomized controlled trials to demonstrate that a laparoscopic approach is better than a mini-laparotomy approach with the microscope. See the overview of the tubal reversal procedure.

The laparoscopic technique does not allow the same magnification and is a less delicate procedure but, apparently, appears to be adequate to produce comparable pregnancy rates.  We caution all patients that we, personally, believe the old-fashioned mini-laparotomy approach is the most likely way to have the best result; however there are good reasons patients choose a laparoscopic approach.

Robotic tubal ligation reversal describes laparoscopy using a robot to assist the surgeon during the procedure. Although this technology simplifies the procedure for surgeons, for the experienced laparoscopist, who already performs tubal ligation reversal without the need for robot assistance, the costs do not appear to justify the use of the robot. Usually, use of the robot increases cost by $2,000 to $3,000.

We have considered whether to use the robot for our laparoscopic tubal ligation reversals but nearly all of our patients pay for the procedure themselves (no insurance coverage) and it is not cost-effective to utilize the robot for a procedure we can perform with standard laparoscopy. This is especially true given that there are no research studies indicating that the robot improves pregnancy rates compared to standard laparoscopic technique.

If a center offers you robotic laparoscopic tubal ligation and you are paying out-of-pocket consider whether use of this technology is really necessary. If there are no differences in outcomes why would you want to pay more?  Some doctors are looking to expand their experience using the robot.  Make sure you ask your surgeon how many procedure he/she has performed and compare prices of different approaches.

We have the confidence to extend our partial refund guarantee to the laparoscopic tubal reversal surgery patients also. Not everyone is a laparoscopic candidate- with excessive weight being the main limitation to its use. As with mini-laparotomy, not everyone is eligible for the refund guarantee. For instance, some women who had their “tubes tied” with a multiple burn technique may be eligible for tubal reversal surgery but, depending on the extent of the burns, may have a lower chance for success and not be eligible for our refund program. This is an unusual situation because the vast majority of women are eligible for the refund program whether we are “untying” the tubes laparoscopically or by mini-laparotomy.