We do a lot of tubal reversals at Lakeshore Surgical Center; as a matter of fact, that’s all we do and very few of them could be done by laparoscope.
What patients who have looked in to it have told us is that the doctor said: “We’ll try to do your tubal ligation reversal with the laparoscope but you will have to agree that we can do a laparotomy if need be”. In other words, “we may have to open your tummy up anyway”.
We use a minilaparotomy method that lets patients recover as well, if not better than with laparoscopy and the scar is smaller and less visible.
To do a tubal ligation reversal by laparoscopy requires 5 separate small incisions to place the instruments in. One goes in your belly button two on either side half way between the level of your belly button and your pubic hair line and two on either side at the level of the pubic hair line. The total length of these incisions for laparoscopic tubal reversals is about three inches.
With our method for tubal reversal, the incision is 2 to 3 inches and right at the pubic hair line and under most bikinis. One of the things about our method of reversal is that we actually sew inside the tubal opening to outside, I have never done a tubal reversal with a laparoscope, but I know the magnification is not good enough to do tubal reversals the way we do them.
Those doctors that have reported on their experience with laparoscopic tubal ligation reversals say that operating times are longer with laparoscopic tubal reversals. To be fair, this might improve if more surgeons do more cases and there is more experience with this technique.
The published results with laparoscopy are not as good as with minilaparotomy and the cost is much higher. I just feel that the best way by far from a comfort standpoint and from a quality standpoint is to do tubal reversals with the minilaparotomy technique that we use. You will be back at your normal activity with less discomfort and less expense if your tubal reversal is done here. At this writing (Jan 08) some docror has posted a video of a laparoscopic tubal on the You Tube site. It is a pretty awful job. The doctor uses heat to seal off a bleeder near the end of the tube which you should never do because it kills the tissue. He uses an absorbable suture on the tube, another big no-no. Worst of all he wastes about 3 centimeters of tube (length matters). There is just no way to reverse tubes with a laparoscope and do a propper job.