Laparoscopically assisted extracorporeal neosalpingostomy. A case report.

BACKGROUND: Laparoscopic neosalpingostomies can be time consuming, costly and technically difficult, resulting in suboptimal results in inexperienced hands. Extracorporeal techniques for pelvic and abdominal organs have already been previously reported in the literature, involving such organs as the appendix, ovary and small bowel. CASE: A 33-year-old white woman, gravida 0, diagnosed with a history of primary infertility, underwent diagnostic laparoscopy/hysteroscopy. Stage IV endometriosis was diagnosed and was accompanied with bilateral tubal occlusion with complete obliteration of the fimbriae bilaterally. Extracorporealization of the fallopian tubes was performed followed by microsurgical neosalpingostomies. Operative time for both neosalpingostomies was 20 minutes. CONCLUSION: When controlled for tubal mucosa integrity, previous data from one researcher comparing microsurgical laparotomy and laparoscopic neosalpingostomies shows a higher fertility rate with open surgical techniques. This may be explained, in part, by suboptimal repair of the distal tubes by a laparoscopic technique. This extracorporeal technique may aid in shorter surgery and anesthesia times, higher intrauterine pregnancy rates and higher successful surgical completions. Prospective evaluation of multiple patients will be necessary to assess its efficacy. Even if pregnancy rates do not differ, operative time and cost may be significantly reduced.