Alvin M. Siegler

Reconstruction of fallopian tubes in previously sterilized patients.

Restoration of tubal patency after surgical sterilization in which the luminal continutiy is interrupted requires either uterine implantation of the patent distal segment or resection and end-to-end anastomosis of patent adjacent segments. Although it is logical to assume that after most tubal ligations the intramural segment remains normal and end-to-end anastomosis is possible, both segments should be evaluated and tested prior to the plastic reconstruction. The results of 178 operations collected from the literature and the authors 23 attempts at surgical reversal of previous tubal operations for surgical sterilization were described. The over-all pregnancy rate after resection and end-to-end anastomosis was 39.0%; after uterotubal implantation, it was 19.4%. The latter procedure was performed in 60% of the patients. The small series of reports makes it difficult to evaluate conception rates or to judge the merits of specific reconstructive operative techniques.

Surgical treatments for tuboperitoneal causes of infertility since 1967.

Surgical treatment for tuboperitoneal causes of infertility since 1967 is discussed. At present sterilization should be represented only as irreversible. Although tubal reconstruction can be offered it is important to explain that the attempted reversal requires an operation under general anesthesia lasting 3-4 hours and demanding considerable skill and training. Preliminary results of dilating or stretching phimotic ostia lysis of obstructing periadnexal adhesions and ampullary salpingoneostomy are encouraging; however they require extreme dexterity. The outstanding successes in tuboplasty occasionally reported have not been duplicated by others and therefore some skepticism is justified concerning microsurgery despite preliminary findings showing markedly increased pregnancy rates. Maintenance of the patent tube is a problem. The trend has been to avoid intratubal devices splints or stents. Hoods are utilized and their benefits are thought to outweigh the disadvantage of the 2nd laparotomy required to remove them. Postoperative hydrotubation appears to be effective and various combinations of medication and tubal washings have been advocated.

An Analysis of Macrosurgical and Microsurgical Techniques in the Management of the Tuboperitoneal Factor in Infertility

One hundred and sixty tubal reconstructions were analyzed according to a classification which describes the type of tubal repair and the tubal segment treated. The results in 80 women who were operated upon just prior to the application of microsurgical principles were compared with those in 80 women in whom these techniques were employed. In expressing the results, no patients were excluded for any reason. Anatomical patency was not evaluated, and functional patency was measured by conception (abortion, tubal, or term pregnancy). Of the 80 women who had tuboplasty with conventional surgery, 10 (12.5%) successfully delivered at term, but 14 (17%) had tubal gestations. Almost 28% of the women (22) had successful pregnancies after microsurgery, but in 9 (11%) extrauterine pregnancies resulted. The three women with current intrauterine pregnancies could improve the microsurgical series to 31% successful pregnancies. Our initial experience with microsurgical techniques seems to show an increased number of term pregnancies, principally in patients who have undergone anastomosis.

Tubal plastic surgery: a retrospective study of 50 cases.

Abstract 1. Fifty tubal plastic operations were performed on 46 infertile women. 2. The classic division of surgical procedures accounted for only 18 of these cases and the remainder of the women had combined operations. 3. Histologic study of the excised oviductal tissue was stressed and the high incidence of diverticulosis in cornual occlusion was noted. 4. Three term pregnancies occurred in patients who had no obstructive fimbrial disease which required salpingostomy, and one patient is currently in the third month of pregnancy. (November, 1962.)

Hysteroscopic procedures in 257 patients.

Two hundred and fifty-seven hysteroscopic examinations were performed on patients who complained primarily of infertility and abnormal uterine bleeding. Organic intrauterine lesions were identified, and correlations were made with preoperative hysterograms and the tissue obtained for pathologic evaluation. The technique proved of special value for the location and resection of intrauterine adhesions and the identification and removal of misplaced intrauterine devices. Failure to observe the cavity adequately and to complete the examination occurred in 20 (8%) of the patients. The most serious complication, uterine perforation, occurred in five instances but did not require additional treatment.

Trends in laparoscopy

A review of 76 reports covers laparoscopy in its history applications methods gynecologic indications accompanying procedures contraindications and complications. Greater detail is given for blood gas studies the uses in the case of salpingitis tubal pregnancy sterility malformations and biopsy of cul-de-sac fluid and cysts. The technique and the appearance through the laparoscope are illustrated in 19 figures.

The 100th Anniversary of Tubal Sterilization

n Tubal sterilization is a relatively new operation within gynecology. The history of tubal sterilization since 1809 is traced through old medical texts. Certain details of the procedures being performed to effect tubal sterilization are reviewed. Although laparoscopic tubal sterilization seems to have been tried 1st in 1941, more than 1/4 of a century elapsed before it gained in popularity as a method of sterilization.n

Removal of ectopic intrauterine contraceptive devices aided by laparoscopy

Abstract Eight instances of intraperitoneal intrauterine contraceptive devices (IUDs) extracted with the aid of laparoscopy are reported. Five different types of devices were removed with accessory instruments. Laparoscopy is a good surgical procedure for observing the location of the intraperitoneal IUD and enables their extraction under observation. It is safer to remove an iatrogenic foreign body (an open or closed loop device) than to await the onset of clinical symptoms.

An instrument to aid tubal sterilization by laparoscopy.

n A single-handled instrument, developed by Siegler for his two-incision technique, has broad biopsy capability. The shaft and handle are insulated to protect the operator from shock; the jaws rotate independently from the handle position; an O-ring seal in the cannula eliminates the need for external sealing devices for carbon dioxide maintenance; and either the cutting or coagulation power may be applied. The biopsy instrument can coagulate and biopsy both tubes without removing the forceps after treating one side since the jaws are large enough to accommodate both segments. The instrument is manufactured by the American Cystoscope Makers, Inc., Pelham Manor, New York.n

The cervical glucose as an indicator of ovulation: A clinical study

U R I N E sugar analysis paper (Tes Tape) can determine reliably the amount of glucose present in solution. Comer4 analyzed 1,500 urine samples with known concentration of glucose. He indicated that the test paper was specific for glucose and accurate in 96 per cent of the cases. Bell and Jumper1 confirmed the accuracy of his work. In 104 samples which were made by the addition of predetermined amounts of glucose to normal urine, they found the test to be specific for glucose. These investigators stressed that the enzyme must be protected against the destructive action of heat, air, and light. Reactions must be read at specific time intervals. When used with due care the test is reliable and is a practical method for glucose detection in clinical glycosuria. Birnberg and KurzrokZ believed that the amount of glucose in the cervical mucus could be determined accurately by this semiquantitative specific test paper. The approach of ovulation was heralded by the appearance of smaller amounts of the glucose, and glucose was detected at the time of ovulation in maximum concentration. Initially these chemical changes were demonstrated calorimetrically with urine sugar analysis paper (Tes Tape) and in their subsequent studies with glucose reagent applicator sticks. Insemination of 27 consecutive patients at the time of ovulation selected by