Unilateral laparoscopic tubal reversal versus IVF

PubMedID: 24001156Background: Tubal sterilization is one of the most important surgical techniques for sterilization. There is a dilemma for women who wish to undo this procedure in the choice between tubal reversal or in vitro fertilization (IVF). Patients and Methods: In this retrospective cohort study, 134 patients who had had tubal sterilization previously and wished to have another child were enrolled in this study. Primary outcome was clinical pregnancy. The outcomes of 58 women who had had laparoscopic unilateral tubal reversal (Group 1) were compared with those of 76 women who had had IVF (Group 2). Results: Clinical pregnancy rates were higher in the tubal reversal group (55.2% in Group 1 and 15.8% in Group 2). Ectopic pregnancy rates were similar (1.7% in Group 1 and 1.3% in Group 2) between the two groups. Clinical pregnancy rates were higher in all age, body mass index, and interval from ligation categories. Conclusions: Laparoscopic unilateral tubal reversal is an important alternative to IVF. However, this is an advanced laparoscopic operation, and more surgeons skilled in this microsurgical operation are still needed. © Copyright 2013, Mary Ann Liebert, Inc. 2013

Laparoscopic microsurgical tubal re-anastomosis: The two-stitch technique

The objective of this study was to determine the effectiveness of the two-stitch unilateral laparoscopic sterilization reversal. Thirty-three patients who had undergone unilateral laparoscopic sterilization reversal between December 2001 and October 2006 were examined. Twenty patients (60.6%) who had had laparoscopic unilateral tubal sterilization reversal achieved an ongoing pregnancy within 1 year of the operation. In vitro fertilization (IVF) was recommended to the other 13 patients, including one patient (3%) who had an ectopic pregnancy. In conclusion, in our study, the pregnancy rate after unilateral two-stitch laparoscopic tubal reversal was 60.6%. In this IVF era, tubal anastomosis will become more popular, causing fewer women to resort to IVF and experience a completely natural conception, making surgery complementary to ART. The number of surgeons skilled in laparoscopic tubal surgery must, therefore, be increased. © 2008 Springer-Verlag

The effect of tubal ligation scoring and sterilization counseling on the request for tubal reanastomosis

PubMedID: 17056453Objective: The aim of this study is to emphasize the role of counseling methods that are meant to decrease the request for tubal ligation reversal, such as tubal ligation scoring. Method: This study covers 389 patients who were admitted for tubal sterilization to Çukurova University, Faculty of Medicine, Obstetrics and Gynecology Department, between 1 January 1990 and 31 December 1999. We have used the 'Tubal ligation score' on these 389 patients. Four hundred and seventeen patients who underwent bilateral Pomeroy type tubal ligation during cesarean section without having undergone tubal ligation scoring in the same time interval, were accepted as the control group. Results: Laparoscopic tubal ligation (with a Yoon ring) was performed on 368 patients who had a score of 6 or higher. Twenty-one patients who got a score of 6 or lower were recounseled and another family planning method was prescribed to them. None of the 368 patients to whom tubal ligation scoring was done previous to laparoscopic tubal ligation returned to our clinic for tubal reanastomosis. Fifteen of the 417 patients (3.6%) in the control group returned to our clinic for tubal reanastomosis. Conclusion: Tubal ligation scoring may decrease the ratio of patients who request a tubal ligation reversal. © 2006 European Society of Contraception

Laparoscopic microsurgical tubal reanastomosis: A preliminary study

PubMedID: 12428936Objective: To determine the effect of laparoscopic reversal of tubal sterilization on pregnancy rate. Methods: Eight patients who underwent laparoscopic tubal reversal between March 1999 and 31 December 2001 were evaluated. Results: Four of eight patients who had had laparoscopic tubal reversal became pregnant. Three have delivered; pregnancy in the fourth woman is ongoing. To date, the other four patients are still not pregnant. Two of these four cases have tubal patency but have not achieved pregnancy; in the other two cases, the operation was unsuccessful and tubal patency did not occur. Conclusion: In our preliminary study, the pregnancy rate was 50%

The ultrastructural effects of surgical treatment of hydrosalpinx on the human endometrium: a light and electron microscopic study

PubMedID: 30966840Hydrosalpinx is a disease commonly observed in women and characterized by the obstruction which is in the shape of a fluid-filled sac at the distal part of tuba uterina closed to the ovary. In this study, we aimed to obtain endometrial tissue samples from the hydrosalpinx patients, before and after the surgical treatment and compare these endometrial tissue samples by using light and electron microscope. Endometrial tissue samples were obtained from the 24 women with bilateral hydrosalpinx range 19–46 years before and after the surgical treatment, and normal endometrial tissues were collected from five women without hydrosalpinx and evaluated as a control group. In endometrial samples of hydrosalpinx patients; it was observed that large and unregulated interstitial spaces representing the organellar destruction, membranous whorl structures associated with organelle destruction, thinning in the surface epithelium, decreasing in numbers of microvillus and pinopodes in microvilli cells, increasing in heterochromatin and picnotic changes in the nucleus, expansion, and vacuolization in the endoplasmic reticulum cisternae in the apical cytoplasm and intraepithelial macrophages and lymphocytes were rised in number. Although mild structural changes were observed in endometrial tissues obtained after surgical treatment of hydrosalpinx, surface epithelium, glandular and stromal cell structures were more similar to control endometrial specimens. In conclusion; serious structural changes have occurred in endometrial tissues of hydrosalpinx patients. These structural abnormalities have removed after surgical treatment so it is considered that surgical treatment is effective in patients with hydrosalpinx. © 2019, © 2019 Taylor & Francis Group, LLC.Firat University Scientific Research Projects Management Unit: EMK2017, TYL-2015-4528This study was supported by a grant from Cukurova University Scientific Research Projects Coordination Unit (Project number: TYL-2015-4528). This work was partially presented at the 23rd National Electron Microscopy (EMK2017) Congress in Antalya-Turkey

Effects of methotrexate on the tubal morphology of rabbits: Evaluation by electron microscopy

PubMedID: 18196902Background/Aims: To evaluate by electron microscopy the effects of methotrexate on the tubal morphology of rabbits. Methods: Biopsies were taken from the isthmic portion of both tubes of 4 rabbits in the control group. 1 mg/kg methotrexate was injected in the left tubes and as a control, a 14-gauge fine needle was used to puncture the right tubes of 10 rabbits in the study group. One month later, tubal biopsies were taken from both tubes of every rabbit in the study group. To mimic pregnancy, 100 IU hCG was injected intramuscularly to every rabbit 24 h before every surgery. On examination by electron microscopy, the effects of methotrexate and of the damage with the fine needle on the tubes were compared to the control group. Results: Young epithelial cells of the methotrexate-injected fallopian tubes kept their normal structure, but others contained important ultrastructural changes. These were: nuclear pyknosis, cytoplasmic vacuolization, dilatation of endoplasmic reticulum cisternae, increased cytoplasmic density and compound cilia. Conclusion: Degenerative changes on epithelial cells caused by the temporary blockage of mitotic activity associated with local methotrexate injection are reversible through the formation of new epithelial cells. Copyright © 2008 S. Karger AG

Removal of intra-abdominal intrauterine device by laparoscopy

PubMedID: 12041860Objective: In this study, we aimed to evaluate the cases in which intra-abdominal intrauterine devices (IUDs) were removed by laparoscopy. Methods: A retrospective study, from 1994 to 2000 was carried out with eight patients who underwent laparoscopy for the removal of an IUD. The patients admitted to our clinic with 'lost IUD' were examined by pelvic ultrasonography, X-ray and hysteroscopy. IUDs were found to be extrauterine but within the abdominal cavity. The IUDs were removed by operative laparoscopy. Results: The mean age of the patients was 31.5 years. The mean duration of usage of IUD was 5.5 years. The IUD was located in the cavity of Douglas in four cases, in the posterior wall of the uterus (perimetrium) in one case and in the conglomerated mass bordered by the intestines in three cases. The types of the IUDs were Cu-T 380A (n = 5), Multiload (n = 1) and Lippes-Loop (n = 2). The mean laparoscopic operation time was 25 min. No major complications (intestinal or vessel injuries) or minor problems occurred. Laparotomy was not necessary in any of the eight cases. All cases were treated as out-patients and discharged on the same day. After counselling, three women requested sterilization, which was performed at the same laparoscopy session by the administration of bilateral Yoon rings, and other family planning methods were chosen by five women. There were no problems when cases were followed at the 10th and 30th postoperative days. Discussion: Our results support the idea that, in cases of extrauterine but intra-abdominal IUD, laparoscopic removal of the IUD must be the first choice of therapy

Make notifications great again: learning how to notify in the age of large-scale vulnerability scanning

As large-scale vulnerability detection becomes more feasible, it also increases the urgency to find effective largescale notification mechanisms to inform the affected parties. Researchers, CERTs, security companies and other organizations with vulnerability data have a variety of options to identify, contact and communicate with the actors responsible for the affected system or service. A lot of things can – and do – go wrong. It might be impossible to identify the appropriate recipient of the notification, the message might not be trusted by the recipient, it might be overlooked or ignored or misunderstood. Such problems multiply as the volume of notifications increases. In this paper, we undertake several large-scale notification campaigns for a vulnerable configuration of authoritative nameservers. We investigate three issues: What is the most effective way to reach the affected parties? What communication path mobilizes the strongest incentive for remediation? And finally, what is the impact of providing recipients a mechanism to actively demonstrate the vulnerability for their own system, rather than sending them the standard static notification message. We find that retrieving contact information at scale is highly problematic, though there are different degrees of failure for different mechanisms. For those parties who are reached, notification significantly increases remediation rates. Reaching out to nameserver operators directly had better results than going via their customers, the domain owners. While the latter, in principle, have a stronger incentive to care and their request for remediation would trigger the commercial incentive of the operator to keep its customers happy, this communication path turned out to have slightly worse remediation rates. Finally, we find no evidence that vulnerability demonstrations did better than static messages. In fact, few recipients engaged with the demonstration website.Accepted Author ManuscriptOrganisation and Governanc