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Laparoscopic Reconstruction of Fallopian Tubes

The fallopian tubes are symmetrical paired tubular organs that connect the peritoneal cavity to the endometrium in the uterine cavity. The fallopian tubes are more than simple conduits or "open pipes." The fallopian tubes capture the ovum after ovulation and serve as a conduit for its travel toward the uterus. Fertilization of the egg by the sperm occurs in the fallopian tube. Following fertilization, the zygote develops into an embryo and continues to travel through the fallopian tube into the uterine cavity, where it implants in the endometrium. The fallopian tubes provide the environment and conditions for conception and for the early development of the conceptus.

Furthermore, the ovum, zygote, and embryo have no intrinsic motility. The fallopian tube is both the conduit and the transporter of the ovum and the early conceptus. Tubal function also aids transport of sperm to the site of fertilization. The fallopian tubes are thus essential and necessary in normal, natural, unassisted reproduction in women.

The multiple and complex functions of the fallopian tubes can be affected by disease, resulting in infertility and, in extreme cases, sterility. Fallopian tube reconstruction has been the traditional method of restoring reproductive function to women with tubal infertility. Today, in vitro fertilization (IVF) and embryo transfer (ET) bypass the fallopian tubes in the reproductive process and are additional options in the treatment of these patients.

Problem:

The fallopian tubes have critical functions in the reproductive process, including providing a conduit from the peritoneal cavity to the uterine cavity. The uterine cavity is the site of implantation and pregnancy. Fertilization and early embryonic growth occur in the fallopian tubes. The secretory cells of the tubal mucosa must provide the nutrients and growth factors necessary at the time of conception and for successful early embryonic development.

The fallopian tubes are involved in the transport of the ovum and sperm to the site of fertilization and in the movement of the early embryo to the uterine cavity. The ciliary motion of cells lining the tubal mucosa and the coordinated muscular activity of the uterus/fallopian tubes result in the successful transport of the gametes and early embryo through the fallopian tubes. These functions are partly regulated by the cyclical hormones of the reproductive cycle. Tubal secretory and muscular functions require normal circulation and neuronal input. Tubal blockage, damage to the tubal mucosa and muscularis, and disruption of circulatory and neuronal inputs to the fallopian tube can result in infertility and increase the risk of tubal ectopic pregnancy.

Surgical techniques to reconstruct the fallopian tubes must achieve patency while minimally disrupting the tubal and pelvic anatomy in order to preserve subsequent function. Microsurgical technique in tubal reconstructive surgery best accomplishes these goals.

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