Histological Evaluation of a New Concept Eliminating the Need for Suture or Glue During Fallopian Tube Anastomosis in the Sheep Model[*]

Zusammenfassung

Fragestellung: Histologische Evaluation einer neuen Technik zur Tubenanastomose im Tiermodell. Methode: Eileiter von 12 Schafen wurden bilateral durchtrennt. Ausgehend vom Fimbrientrichter wurde ein Polyvinylkatheter in die Tube eingefügt. Die freien Enden wurden zusammengefügt und der Katheter mithilfe von Titanklemmen ohne Verwendung von Faden oder Klebematerial fixiert. Die Operationsdauer, die Tubendurchgängigkeit, die Bildung von Fibrosen, Granulomen, Entzündungen und Lumenänderungen wurden 30 Tage nach Eingriff evaluiert. Ergebnisse: In 21 (87,5 %) der resezierten Tuben konnte durchgängiges Epithel gefunden werden. Akute entzündliche Veränderungen und Fistelbildung wurden in 2 (8,3 %) beziehungsweise in 1 (4,2 %) der Fälle beobachtet. Es gab keine Fibrosen oder Granulome. Schlussfolgerung: Die Verwendung eines inerten Katheters für die tubare Anastomose im Tiermodell führt in situ zu einer hohen Rate an Reepithelisierung. Die vorgestellte Technik verspricht eine mögliche Anwendung in der Tubenrekonstruktion.

Abstract

Objective: To evaluate the pathological outcomes of a newly introduced technique for tubal anastomosis in an animal model. Materials and Methods: The uterine tubes of 12 sheep were transected bilaterally. A polyvinyl chloride catheter was passed through the fimbrial end. The resected ends were approximated, and the catheter was fixed in place using titanium clips. No suture material or glue was used. The time required for the procedure, patency of the tubes, fibrosis, giant cell reaction, inflammation, and luminal changes were evaluated 30 days after surgery. Results: Epithelial continuity was present in 21 (87.5 %) of the resected tubes. Acute inflammatory changes and herniation leading to fistulization were observed in 2 (8.3 %) and 1 (4.2 %) of the specimens, respectively. There was no fibrosis or giant cell reaction. Conclusion: Passage of an inert catheter left in situ for tubal anastomosis is associated with a high rate of reepithelization in an animal model. Our technique might have potential use in uterine tube reconstruction.

Eileiterrekonstruktion - Tubenanastomose - Katheter

Fallopian tube anastomosis - catheter - tubal anastomosis

References

• 1 Caballero-Gomez J M, Ortega-Moreno J. Study of two simplified microsurgical techniques for uterine horn anastomosis in rat.  Arch Gynecol Obstet. 1993;  252 191-195
• 2 Kerin J F, Surrey E S. Tubal surgery from the inside out: falloscopy and balloon tuboplasty.  Clin Obstet Gynecol. 1992;  35 299-312
• 3 Confino E, Tur-Kaspa I, DeCherney A, Corfman R, Coulam C, Robinson E, Haas G, Katz E, Vermesh M, Gleicher N. Transcervical balloon tuboplasty: a multicenter study.  JAMA. 1990;  264 2079-2082
• 4 Ribeiro S C, Tormena R A, Giribela C G, Izzo C R, Santos N C, Pinotti J A. Laparoscopic tubal anastomosis.  Int J Gynecol Obstet. 2004;  84 142-146
• 5 Penzias A S, DeCherney A H. Is there ever a role for tubal surgery?.  Am J Obstet Gynecol. 1996;  174 1218-1223
• 6 Posaci C, Camus M, Osmanagaoglu K, Devroey P. Tubal surgery in the era of assisted reproductive technology: clinical options.  Hum Reprod. 1999;  14 120-136
• 7 Koh C H, Janik G M. Laparoscopic microsurgical tubal anastomosis.  Obstet Gynecol Clin North Am. 1999;  26 189-200
• 8 Kaloo P, Cooper M. Fertility outcomes following laparoscopic tubal re-anastomosis post tubal sterilisation.  Aust N Z J Obstet Gynaecol. 2002;  42 256-258
• 9 Gauwerky J F, Reinecke M, Forssmann W G. Fibrin glue anastomoses of the uterine tube using various experimental conditions.  Arch Gynecol Obstet. 1989;  245 419-424
• 10 Gauwerky J F, Klose R P, Vierneisel P, Bastert G. Fibrin glue for reanastomosis of the fallopian tube in the rabbit: adhesions and fertility.  Hum Reprod. 1992;  7 1274-1277
• 11 Gauwerky J F, Klose R P, Forssmann W G. Fibrin glue for anastomosis of the fallopian tube - morphology.  Hum Reprod. 1993;  8 2108-2114
• 12 Gauwerky J F, Klose R P, Forssmann W G. Healing of tubal anastomoses - microsurgery vs. fibrin gluing: morphologic aspects.  Zentralbl Gynäkol. 1994;  116 173-178
• 13 Haj N, Haj M, Shasha S M, Oettinger M. Tubal anastomosis in the rat using the tissue adhesive cyanoacrylate (Histoacryl).  Gynecol Obstet Invest. 1994;  38 54-56
• 14 Caballero-Gomez J M, Ortega-Moreno J. Anastomosis of uterine serosa with cyanoacrylate versus suture in rats.  Acta Obstet Gynecol Scand. 1993;  72 210-213
• 15 Rajaram S, Rusia U, Agarwal S, Agarwal N. Autologous fibrin adhesive in experimental tubal anastomosis.  Int J Fertil Menopausal Stud. 1996;  41 458-461
• 16 Weis-Fogh U S, Pedersen H, Schroeder E, Sorensen S S, Olesen H P. Histomorphological evaluation of wound healing of rabbit oviduct after microsurgical reanastomosis with the use of autologous fibrin adhesive, human fibrin adhesive or poly-glycolic acid suture.  Eur Surg Res. 1993;  25 278-286
• 17 Hurwitz A, Amir G, Yagel S, Palti Z, Adoni A. A single continuous suture as a possible alternative to the interrupted suture for tubal anastomosis.  Int J Fertil. 1990;  35 125-128
• 18 Dubuisson J B, Swolin K. Laparoscopic tubal anastomosis (the one stitch technique): preliminary results.  Hum Reprod. 1995;  10 2044-2066
• 19 Bissonnette F, Lapensee L, Bouzayen R. Outpatient laparoscopic tubal anastomosis and subsequent fertility.  Fertil Steril. 1999;  72 549-552
• 20 Kao L W, Giles H R. Comparison of laser-assisted anastomosis, laser welding, and microsurgical anastomosis of rabbit uterine tubes.  Obstet Gynecol. 1993;  81 122-126
• 21 Badawy S Z, ElBakry M M, Baggish M S. Comparative study of continuous and pulsed CO₂ laser on tissue healing and fertility outcome in tubal anastomosis.  Fertil Steril. 1987;  47 843-847
• 22 Kao L W, Giles H R. Laser-assisted tubal anastomosis.  J Reprod Med. 1995;  40 585-589
• 23 Choe J K, Dawood M Y, Bardawil W A, Andrews A H. Clinical and histologic evaluation of laser reanastomosis of the uterine tube.  Fertil Steril. 1984;  41 754-760
• 24 Wallwiener D, Meyer A, Bastert G. Carbon dioxide laser tissue welding: an alternative technique for tubal anastomosis?.  J Clin Laser Med Surg. 1997;  15 163-169
• 25 Margossian H, Garcia-Ruiz A, Falcone T, Goldberg J M, Attaran M, Miller J H, Gagner M. Robotically assisted laparoscopic tubal anastomosis in a porcine model: a pilot study.  J Laparoendosc Adv Surg Tech A. 1998;  8 69-73
• 26 Margossian H, Garcia-Ruiz A, Falcone T, Goldberg J M, Attaran M, Gagner M. Robotically assisted laparoscopic microsurgical uterine horn anastomosis.  Fertil Steril. 1998;  70 530-534
• 27 Falcone T, Goldberg J M, Margossian H, Stevens L. Robotic-assisted laparoscopic microsurgical tubal anastomosis: a human pilot study.  Fertil Steril. 2000;  73 1040-1042
• 28 Degueldre M, Vandromme J, Huong P T, Cadiere G B. Robotically assisted laparoscopic microsurgical tubal reanastomosis: a feasibility study.  Fertil Steril. 2000;  74 1020-1023
• 29 Goldberg J M, Falcone T. Laparoscopic microsurgical tubal anastomosis with and without robotic assistance.  Hum Reprod. 2003;  18 145-147
• 30 Weinrib H P, Dmowski W P. Absorbable external rings for anastomosis of the fallopian tubes: a feasibility study.  Fertil Steril. 1985;  44 419-422
• 31 Tredway D R, Kirsch W M, Zhu Y H, Weber K, Norburg M, Saukel G W, Seraj I. A new concept for anastomosis of the fallopian tube: tissue reconstruction with nonpenetrating, arcuate, legged clips in the rat model.  Fertil Steril. 1994;  62 624-629
• 32 Zhu Y H, Kirsch W M, Tredway D, Weber K, Norburg M, Saukel G W, Oberg K C, Seraj I, Chrisler J. Nonpenetrating, arcuate-legged clip reconstruction of the rat uterine horn.  J Am Assoc Gynecol Laparosc. 1994;  1 395-400
• 33 Kirsch W M, Zhu Y H, Gaskill D, Stewart S, Hardesty R A, Lyons T L. Tissue reconstruction with nonpenetrating arcuate-legged clips. Potential endoscopic applications.  J Reprod Med. 1992;  37 581-586
• 34 Mettler L, Ibrahim M, Lehmann-Willenbrock E, Schmutzler A. Pelviscopic reversal of tubal sterilization with the one- to two-stitch technique.  J Am Assoc Gynecol Laparosc. 2001;  8 353-358

1 Supported in part by the Scientific Research Fund of Suleyman Demirel University, Isparta, Turkey