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  • Title: Microsurgery of the fallopian tube: from fantasy to reality.
    Author: Winston RM.
    Journal: Fertil Steril; 1980 Dec; 34(6):521-30. PubMed ID: 7004914.
    Abstract:
    The author presents 4 examples of experimental research being conducted in the techniques of microsurgery in animals. The surgically modified oviduct, capture of ova by the fimbriae, adhesion formation, and the pathophysiology of damaged tubes have been dealt with through microsurgery. Similar microsurgical techniques were applied clinically and the reported results are essentially raw data to be analyzed in the future. The operating microscope is used for all infertility surgery and it can be used over a range of magnifications. Other instruments are also mentioned, e.g., telescopic spectacles. The surgical approach is dealt with--routinely employed is the Pfannenstiel incision, a large incision. Tissues are handled as little as possible since peritoneal raw areas are an important precursor of later adhesion formation. Nonabsorbable sutures are best and nylon appears to cause the least reaction. It is helpful to leave hydrocortisone acetate in the peritoneal cavity to prevent adhesions. The success of tubal anastomosis is dependent on the method used and the patient selected. For example, of those with diathermy burns, 55% conceived. With diathermic coagulation, the pelvis remains relatively clean and the tubes adhesion-free. The authors, however, maintain that isthmic-isthmic anastomosis is best. The microscope is also used in cases of fimbrial damage; however, the results are poor. Results after repeat salpingostomy following previous surgery are even worse; of 59 patients, only 8.4% had term pregnancies. The technique is superior to those results obtained with implantation. While microsurgery is a tremendously useful technique, it would be better to develop better methods of preventive medicine. Furthermore, adequate training for microsurgery should come in the form of a fellowship at an appropriate institution.
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