My doctor referred me to a local group for robotic surgery to reverse my tubal ligation but it is very expensive, what do you think?

There are no advantages to either robotic or laparoscopic tubal reversal, period, exclamation point! There are no advantages in recovery time after surgery, Laparoscopic or robotic surgery require a minimum of 4 incisions at various places in the abdomen, all of which will show in any 2-piece bathing suit. The incision we use is 2 inches right at or below your hair line and you will have to look a long time to find a bathing suit that will show it.  I want you to think about the last time you tied your shoes. You could feel when the knot was tight. You probably did not look to see if they were tied properly because your hands told you they were right. With robotic or laparoscopic surgery that feel is lost, they look at a television monitor to tie the sutures and hope for the best. Another important consideration is suture material. We use 8-0 or sometimes 9-0 suture that is used in eye surgery. The finer the suture is important because the tube is very tiny and you don’t want thicker sutures to do the reversal. The smallest suture that is available to use robotically is 6-0 (the higher the number the finer the suture). Your robotic or laparoscopic surgeon has to use suture that is 2 to 3 sizes bigger than we use. Remember, smaller suture is better. The final thing for you to consider is experience. Dr. Turner and I have done almost 3000 tubal reversals.

-Dr. William Greene

Why is Closing the Fallopian Tubes in Layers Important?

We know that doctors read these blogs and this is one question that requires a rather technical answer. First of all, we are talking about closing the tubes in layers not just the abdomen because everyone does that. Most doctors that do reversals just sew around the outside of the tube, the serosal layer, with 3 or 4 stitches. The inner lining of the tube is different near the uterus than it is out at the end of the tube near the ovary. Going from inside the tube to the outside the innermost layer is the mucosal, then the muscularis, next the adventitial layer and on the outside the serosal layer.

The changing of the cell layers is called metaplasia. The cells start out all the same but depending on where they are in the tube they become different. I think, but I don’t know, that the changing in the acid level as they get nearer the ovary causes the metaplastic change. We have done almost 3000 reversals and we have a very low ectopic pregnancy rate (2.5 %) that I believe is due to careful layered closure. Dr. Turner and I sew the tubes in layers from inside to out because we believe it gives the best result. We don’t have any argument with physicians that do differently we just know what we feel is best for those patients that put their trust in us to do the best for them.

-Dr. William Greene

Why do you feel experience is so important for a doctor doing tubal reversals?

In surgery, experience is always important. We all are different but our anatomies are generally very similar. When a surgeon operates where someone else has already operated, the anatomy is different with each case because it has been altered by different doctors using different techniques. This is the case with tubal reversal surgeries. There are many different ways to “tie” a woman’s tubes and different ways to do each technique. We only do tubal reversals and we have done almost 3000 and every once and a while Dr. Turner and I will see something we have never seen before. That’s when experience really counts. Some patients present a challenge because of scar tissue from previous operations or particularly thick tummies and we are anxious to be up to the challenge.

There are only a few people in the United States that do a lot of tubal reversals and as far as I know our facility is the only one doing only tubal reversals. I cannot say too many times that this is one time where you can pay less and get more. If someone tells you it will be $7000 to $25000 to do your tubal reversal they just told you they don’t do many. The reason is that insurance seldom covers this type of surgery and very few people have that kind of money.

What do you think about these lawyers advertising that they will sue on behalf of Essure patients?

I am not a lawyer, thank goodness, and neither is Dr. Turner. I would point out that if they want you to join a “class action” the chances that you will ever get any money are very slim. Class action lawsuits allow lawyers to sue on behalf of a group of people and any money gotten is divided between the lawyers and then among the group. Guess who gets the most of the money!

If a lawyer is suing just on your behalf, you should insist they do it on contingency. That means they pay the expenses not you. It’s a good way to make sure they think they have a reasonable chance to win. You should not have to pay a single penny.  I think that in some states if you lose a lawsuit you can be liable for the expense of defending a lawsuit so it’s not all win-win. A minority of Essure patients have damages due to pain and suffering even medical expenses. As bad as we feel for them it is a long uphill road to get money for it.

With so many women reporting issues regarding Essure, there are many sites about Essure problems. How do I know if the people providing the information has any medical training?

With many women reporting issues regarding Essure implants it needs to be reminded that most women who have Essure’s are happy with their choice. As with any other subject, there is a lot of information on the internet and it can be confusing. It seems that many of the “Essure Problem” sites are managed by people with no formal medical training but they can also be managed by people who have an agenda to get you to go to a facility that pays them to act as a front. Our facility keeps a record of all individuals that contact our office, yet we have seen multiple comments from people claiming to have contacted our office or had care at our facility, that never have. It would be one thing if it was one or two people that were making these claims but it seems that there are many (or many profiles) that providing misinformation regarding our facility and how we perform Essure Reversals and Removals.

A minority of women either want to have more children or just want the coils out because of problems. We have several blogs on this site about Essure reversal and Essure removal. One thing needs to be said is that it is dangerous and unwise to have a hysterectomy to get an Essure out. They come out easily and completely with a simple outpatient procedure. If you doctor says that he or she doesn’t know how to remove them without doing a hysterectomy have them call me and I will  be glad to tell them. Dr. Turner and I were the first to ever reverse an Essure in 2007 and we had the first “Essure baby” in 2010. Both events were widely covered in the press because they were firsts and the removal let alone the reversal of this procedure was supposed to be impossible.