[Gynecological laparoscopy] Fallopian tube clamping

Currently, most literature reports that untreated hydrosalpinx has a negative impact on the outcome of IVF-ET, leading to lower embryo implantation rate, clinical pregnancy rate and higher miscarriage rate.

Possible reasons include: ① Hydrosalpinx can flow back into the uterine cavity to wash away the embryo, and the water on the surface of the endometrium interferes with the interaction between the endometrium and the embryo, inhibiting embryo implantation. ② Inflammatory hydrosalpinx damages the receptivity of the endometrium. ③ Hydrosalpinx is often caused by pathogen infection. The clamping of the fallopian tube not only blocks the influence and toxic effects of hydrosalpinx on embryo implantation, but also avoids the possible damage to the blood vessels in the mesentery and the impact on the blood supply to the ovaries when the fallopian tube is removed.

Indications

1. Hydrosalpinx before IVF-ET is the main indication for tubal clamping.

2. Patients who voluntarily undergo tubal sterilization.

Surgical steps and techniques

1. Take the bladder lithotomy position, routinely disinfect and spread the towel, establish pneumoperitoneum, and place the endoscope.

2. Understand the pelvic situation under laparoscopy and separate pelvic adhesions.

3. Salpingostomy and tubal fimbria plasty (this step is the same as salpingostomy plastic surgery).

4. Tubal clamping: Expose the bilateral tubal clamping sites, lift and fix the tubal wall of the isthmus of the fallopian tube with non-destructive forceps, implant the titanium clamp, double clamp the fallopian tube at the proximal end of the isthmus of the left fallopian tube (Figure 2), and press hard to facilitate the closure of the lumen.

Risks and prevention during surgery

1. Bleeding from wound surface Bleeding from wound surface may occur during the separation of adhesions. Try to choose a blood vessel-free area to cut with electrocoagulation scissors or separate with bipolar electric hooks. If the adhesion is thick or there are blood vessels, electrocoagulation can be used first and then cut. The broken ends after separation should be carefully inspected and electrocoagulated to stop bleeding.

2. Injury or rupture of fallopian tube During the separation of adhesions around the fallopian tube, the instruments should be used reasonably to avoid thermal and electrical damage to the fallopian tube as much as possible. When making a plastic stoma, try to avoid forcible tearing that may cause fallopian tube lacerations.

3. Unsatisfactory or failed placement of the titanium clip. If the adhesion around the fallopian tube is severe or the fallopian tube is significantly thickened and hardened, the titanium clip cannot be placed. Other methods such as proximal fallopian tube electrocoagulation and rupture must be changed.

4. Mis-clip the round ligament of the uterus or the proper ligament of the ovary. If the anatomical layer of the adhesion changes or the visual field is not clear, the round ligament of the uterus or the proper ligament of the ovary on the same side may be mis-clipped. Once the mis-clip is found, the titanium clip should be removed in time and re-placed.

5. If the titanium clip is displaced, loosened or falls off, after clamping the fallopian tube, the position of the titanium clip and the clamping effect should be carefully observed. If the titanium clip is found to be displaced, loosened or fallen off, it should be replaced in time and the operation should be repeated.

Postoperative precautions

1. When the surgery is completed, the pelvic and abdominal cavity and the peri-fallopian tube adhesions should be flushed with saline or dexamethasone saline; the adhesion wound surface should be coated with sodium hyaluronate gel to prevent adhesion recurrence; encouraging patients to get out of bed and move around early after surgery can also reduce the risk of re-adhesion.

2. Patients who lose their natural fertility should be fully informed and consented before the fallopian tube clamping surgery, as they will lose their natural fertility after the fallopian tube clamping surgery.

3. If the fallopian tube wall thickens or the titanium clip falls off, the fallopian tube may be recanalized after surgery, and the possibility of interstitial pregnancy or cornual pregnancy increases.

4. If too much mesosalpinx tissue is clamped for chronic pelvic pain, it may affect the blood supply to the ovaries and cause postoperative pain symptoms.

5. Strengthen education and guide patients on how to get pregnant, and inform them to take assisted reproductive methods as soon as possible. However, sexual intercourse is prohibited within 2 weeks after surgery, and heavy physical labor or strenuous exercise should be avoided.