Robotic-assisted laparoscopic tubal ligation reversal is a procedure to restore fertility in women who have had a tubal ligation—a procedure that cuts or blocks the fallopian tubes to prevent pregnancy. Tubal ligation is commonly referred to as a woman having her tubes tied. During a tubal ligation reversal, the blocked segments of the fallopian tubes are reconnected to the remainder of the fallopian tubes, allowing eggs to move through the tubes and sperm to travel up the fallopian tubes to join an egg.
Rochester Regional Health is the first in the region to perform robotic-assisted laparoscopic tubal ligation reversal, helping women who have previously decided against pregnancy to restore their ability to conceive again.
Mohamad Mahmoud, MD, a fellowship-trained minimally invasive and robotic gynecologic surgeon and board-certified in obstetrics and gynecology, who is performing this procedure at Rochester General Hospital, tells us everything there is to know about this new procedure at RGH.
How the procedure is performed
During a tubal ligation reversal, doctors use robotic and laparoscopic surgical equipment—small tubes attached to tiny cameras and surgical instruments—to make a tiny incision on the abdomen and reattach the fallopian tubes.
This allows doctors to remove blocked fragments of the fallopian tube and attempt to repair the tube with tiny stitches.
Who would you recommend this procedure to?
Any woman generally younger than 40 years of age who has had her tubes tied and desires to get pregnant again, doesn’t have other infertility issues, and has enough remaining fallopian tube segments, is right for this procedure.
Before the procedure, your doctor will ask you for a copy of the operative report that describes the process that was used when your tubes were tied. How much of the tube that remains, and the location of the sterilization, are key in determining if tubal reversal surgery may help you conceive.
Doctors may not be able to reattach one or both of your fallopian tubes if too much of the tubes were removed during the tubal ligation.
How soon after can a woman start trying for a baby?
Usually, the tube anastomosis is healed within one month after the procedure. We recommend waiting at least one or two menstrual cycles before attempting to get pregnant.
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Success rate
Success rates after a tubal ligation reversal can vary widely, depending on factors such as maternal age and the type of tubal ligation procedure that was initially done.
While it's difficult to predict the odds of pregnancy after this procedure, younger women—particularly those 35 and under—tend to have much better success rates.
In cases where tubal ligation reversal isn't successful, in vitro fertilization (IVF) may be an alternative option to help women become pregnant.
Recovery time
Recovery is generally a quick one thanks to the minimally invasive robotic-assisted laparoscopic approach we use. Patients can slowly resume normal activity as they begin to feel better, usually within one to two weeks.
Stitches will dissolve on their own and don’t require removal. The procedure is usually an outpatient procedure with the majority of patients allowed to leave the hospital the same day as the procedure.
Who is eligible?
Women usually younger than 40 years of age who have their tubes tied previously with no other known causes of infertility (such as abnormal ovarian reserve, abnormal sperm) are eligible as long as they have enough length of the remaining tube left.
Tubal ligation procedures that cause the least amount of damage to the fallopian tubes are the most likely to allow a successful tubal ligation reversal. Examples include sterilization with tubal clips or rings which have the highest success rate of getting pregnant after reversal.
Other examples include:
- Partial salpingectomy
- Partial removal of a portion of the tube
- Cauterization burning of the tubes, which carry a lower success rate of pregnancy after reversal
- Patients who had a total salpingectomy (removal of the whole tube) are not eligible for tubal reversal
Patients who have had a fibroidectomy procedure (removal of the distant end of the tube) are not eligible.
Is it risky?
The risk of this procedure is the same as any laparoscopic surgery. While the procedure itself has low risk in general, complications of laparoscopic surgery can include infection, bleeding, injury to surrounding organs, scarring of the fallopian tube, and complication from anesthesia.
Patients who undergo tubal reversal are at higher risk of having an ectopic pregnancy—a pregnancy outside the uterus such as tubal pregnancy and need to be monitored closely once pregnant as to rule out this possibility during the early stages of the pregnancy.
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