CPT® Code 58750

1. Indications

The tubotubal anastomosis procedure is indicated for specific conditions related to female reproductive health. The following are the primary indications for performing this surgical intervention:

• Reversal of Tubal Ligation This procedure is commonly performed to reverse a previous tubal ligation, which is a surgical method of permanent contraception.
• Excision of Diseased or Damaged Fallopian Tube Tubotubal anastomosis may also be indicated following the excision of a diseased or damaged portion of the fallopian tube, allowing for the reconnection of healthy segments.

2. Procedure

The tubotubal anastomosis procedure involves several critical steps to ensure successful reconnection of the fallopian tubes. The following outlines the procedural steps:

• Step 1: Abdominal Incision The procedure begins with the surgeon making an incision in the lower abdomen to access the abdominal cavity and reproductive organs. This incision allows for direct visualization and manipulation of the fallopian tubes, uterus, and ovaries.
• Step 2: Visual Inspection Once the abdominal cavity is accessed, the surgeon visually inspects the uterus, fallopian tubes, and ovaries to assess their condition. This step is crucial for identifying any abnormalities or adhesions that may affect the procedure.
• Step 3: Lysis of Adhesions If any adhesions are present around the fallopian tubes, ovaries, or round ligament, the surgeon carefully lyses these adhesions. This process frees the reproductive organs and facilitates better access to the fallopian tubes.
• Step 4: Opening Blocked Tubal Segments The surgeon then proceeds to open the blocked segments of the fallopian tubes. This step is essential for preparing the tubes for reconnection.
• Step 5: Insertion of Stent A narrow flexible stent is threaded from the fimbriated end of the fallopian tube through the tube lumen and into the uterine cavity. This stent serves to ensure that the tube is not obstructed at any point distant from the segment involved in the previous ligation.
• Step 6: Anastomosis of Tubal Segments The two tubal segments are brought together, and a retention suture is placed in the connective tissue beneath the tube. Using microsurgical techniques, the surgeon anastomoses the middle muscular layer of the tube and the outer serosal layer, taking care to avoid disruption of the inner mucosal layer. This meticulous approach is vital for the success of the procedure.
• Step 7: Withdrawal of Stent After the anastomosis is completed, the stent is carefully withdrawn from the fimbriated end of the tube, allowing for the potential restoration of normal tubal function.

3. Post-Procedure

Following the tubotubal anastomosis procedure, patients may require specific post-operative care to ensure proper recovery. It is essential to monitor for any signs of complications, such as infection or excessive bleeding. Patients are typically advised to follow up with their healthcare provider to assess the success of the procedure and to discuss any further fertility treatments if necessary. Recovery time may vary, but patients are generally encouraged to avoid strenuous activities for a period to allow for healing. Additionally, the healthcare provider may provide guidance on managing pain and any other post-operative symptoms.