title: Carbon dioxide laser tissue welding: an alternative technique for tubal anastomosis?
abstract: Microsurgical tubal anastomosis is the gold standard for treatment of tubal occlusion. The present study was performed to establish the feasibility of tubal anastomosis by welding tissue with a defocused CO2-laser beam during laparotomy and with an endoscope. In an animal experiment, 70 white New Zealand rabbits were randomized in 2 study groups (E1, E2) and 3 control groups (C1, C2, C3) as follows: C1, 10 animals, no operation, as controls for the efficiency of the insemination technique; C2, 5 animals, spontaneous healing after tubal segment resection, to quantify spontaneous recanalization of the tube; C3, 15 animals, microsurgical end-to-end adaption after tubal segment resection; E1, 20 animals, laser welded anastomosis after segment resection via laparotomy; E2, 20 animals, laparoscopic laser welded anastomosis after segment resection. The pregnancy rate in C1 was 80%. None of the animals in C2 but 60% of the rabbits in C3 conceived. After sutureless anastomosis by laser welding 50% of the laparotomized, and 40% of the laparoscopically operated group became pregnant. Morphological examination of the oviducts after relaparotomy showed comparable patency rates of 70% in C3, 70% in E1, and 65% in E2. Whereas no dehiscence of anastomoses was observed in C3, 20% of the welded tubes in E1 and 22.5% in E2 were dehiscent. Tubal anastomosis took approximately three times as long laparoscopically as during laparotomy. Thus, laser welding as a sutureless alternative technique of tubal anastomosis should be viewed critically. A reduction of sutures through laser-assisted anastomosis might, however, be considered.
authors.affiliation: Department of Gynecology and Obstetrics, University of Heidelberg, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Wallwiener
authors.forename: A
authors.initials: A
authors.lastname: Meyer
authors.forename: G
authors.initials: G
authors.lastname: Bastert
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D000818:Animals; D002245:Carbon Dioxide; D005187:Fallopian Tubes / Q000601:surgery*; D005260:Female; D020706:Laparoscopes; D007813:Laparotomy; D017075:Laser Coagulation / Q000295:instrumentation / Q000379:methods*; D008866:Microsurgery / Q000379:methods; D011247:Pregnancy; D011817:Rabbits; D013243:Sterilization Reversal / Q000295:instrumentation*
chemical_list: D002245:Carbon Dioxide