Guangzhou Medical University, Guangzhou, China.
Minimally Invasive Gynecology Surgery, Baylor College of Medicine, Houston, Texas.
J Minim Invasive Gynecol. 2019 May-Jun;26(4):607. doi: 10.1016/j.jmig.2018.08.023. Epub 2018 Sep 1.
To investigate the advantages of using robotic assistance in tubal reanastomosis surgery.
A narrated instructional video.
University Hospital, Baylor College of Medicine, Houston, Texas (Canadian Task Force Classification III).
A 33-year-old woman, G2P2003, who regretted her prior tubal ligation; she continued to request for a tubal reversal with a desire to conceive in the near future. A single-site approach was decided on when she expressed concern for the cosmetic aftermath of multiport surgery.
Robotic single-site tubal reanastomosis.
We performed robotic single-site tubal reanastomosis on the patient. We used the energy instruments of the monopolar hook and the bipolar slotted grasper. Entry was performed in the umbilicus, after which an abdominal survey was conducted to determine and locate the blocked fallopian tubes. A cold scissor, to avoid additional damage to the tubes, was used to resect the portion of the right blocked tube, and a neonatal feeding tube was inserted though both sections of the tube to ensure proper alignment during the repair. Additionally, a figure of eight suture was placed in the mesosalpinx to reduce the amount of tension during the tubal reanastomosis. We used 4 interrupted 5-0 PDS sutures, with 2 wristed needle drivers, to establish and precisely align the 2 sections of tube, first in the mucosal layer and then in the serosal layer, to achieve proper retention. Upon successful chromopertubation with methylene blue dye, the process was repeated on the left side. A successful tubal reanastomosis was completed and chromopertubation clearly demonstrated that the tubes were patent. Total operation time was approximately 100 minutes, resulting in a successful surgery. Estimated blood loss was only 20 mL. At 2 months after surgery a fluoroscopic hysterosalpingogram was conducted to verify the patency of the tubes. We concluded that both tubes were patent.
The single-site robotic approach provides a potent and valuable method for tubal reanastomosis, rendering difficult surgical techniques more accessible.
探讨机器人辅助在输卵管吻合术中的优势。
解说教学视频。
贝勒医学院休斯顿大学医院（加拿大卫生保健研究与质量局分类 III 级）。
一位 33 岁的 G2P2003 妇女，她后悔之前做了输卵管结扎术，希望在不久的将来能够再次怀孕，因此要求进行输卵管复通术。当她对多孔手术的美容后遗症表示担忧时，我们决定采用单部位入路。
机器人单部位输卵管吻合术。
我们为患者实施了机器人单部位输卵管吻合术。我们使用了单极钩和双极开槽抓钳的能量器械。手术入口在脐部，然后进行腹部探查，以确定并定位阻塞的输卵管。使用冷剪刀（以避免对管子造成额外损伤）切除右侧阻塞管的部分，然后通过管子的两个部分插入新生儿喂养管，以确保在修复过程中管子的正确对齐。此外，在输卵管吻合术中，在输卵管系膜中放置一个 8 字形缝线，以减少张力。我们使用 4 个间断的 5-0 PDS 缝线，使用 2 个腕式持针器，首先在黏膜层，然后在浆膜层，精确对齐 2 个管段，以实现正确的保留。当用亚甲蓝染料成功进行 chromopertubation 后，在左侧重复该过程。成功完成输卵管吻合术，chromopertubation 清楚地表明管子是通畅的。总手术时间约为 100 分钟，手术成功。估计失血量仅为 20 毫升。术后 2 个月进行了荧光透视子宫输卵管造影术，以验证管子的通畅性。我们得出结论，双侧管子均通畅。
单部位机器人方法为输卵管吻合术提供了一种强大而有价值的方法，使困难的手术技术更容易实现。
