ABSTRACT
Tubal disease represents one of the most important causes of infertility. Although most cases are secondary to sexually transmitted disease, tubal anastomosis represents a significant number of cases. Worldwide, more than 190 million couples have chosen sterilization as their contraceptive method. As many as 20% will express regret due to a change in family circumstances such as the death of a child, an improved economic situation, or a change in marital status; 1-5% of these patients will request sterilization reversal. Tubal disease amenable to surgical intervention can be divided into three approaches:
● cornual – which is treated radiologically or hysteroscopically and will not be covered in this chapter
● midportion – which is typically due to a previous tubal ligation
For couples desiring fertility after tubal ligation, only two options are available: surgical tubal reanastomosis and in vitro fertilization. Tubal reanastomosis can be performed through a laparotomy incision, laparoscopically, or with robotic assistance. Integrated computer robotic systems allow for three-dimensional vision, tremor filtration, and intraabdominal articulation, affording the same advantages as laparo-
tomy to the surgeon. Initial feasibility studies have been optimistic.
