CPT® Code 58752

1. Indications

The tubouterine implantation procedure is indicated for specific conditions related to female reproductive health. The following are the primary indications for performing this procedure:

• Reversal of Tubal Ligation This procedure is performed to reverse a previous tubal ligation, allowing for the possibility of conception.
• Distal Tubal Preservation It is indicated when only the distal portion of the fallopian tube remains intact after a tubal ligation.
• Proximal Tubal Excision Tubouterine implantation may also be indicated following the excision of the proximal portion of a fallopian tube that has been damaged or diseased.

2. Procedure

The tubouterine implantation procedure involves several critical steps to ensure successful reattachment of the fallopian tube to the uterus. The following outlines the procedural steps involved:

• Step 1: Abdominal Incision The procedure begins with the surgeon making an incision in the lower abdomen to access the 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. This step is crucial for assessing the condition of these structures and identifying any adhesions or abnormalities that may need to be addressed.
• Step 3: Lysis of Adhesions If adhesions are present around the fallopian tube, ovary, or round ligament, the surgeon will carefully lysate these adhesions. This process helps to free the reproductive organs and allows for better access to the fallopian tube.
• Step 4: Mobilization of the Distal Tube The distal portion of the fallopian tube is then mobilized. This step is essential for creating a new opening through the uterine wall for the reimplantation process.
• Step 5: Creation of Uterine Opening A new opening is created in the uterine wall, which serves as the entry point for the distal tubal segment.
• Step 6: Insertion of Tubal Segment The mobilized distal portion of the fallopian tube is inserted through the newly created opening into the uterine cavity. This step is critical for reestablishing the pathway for potential fertilization.
• Step 7: Microsurgical Suture Finally, using microsurgical techniques, the surgeon sutures the fallopian tube to the uterine wall. This meticulous suturing is vital for ensuring that the tube remains securely attached and functional.

3. Post-Procedure

After the tubouterine implantation procedure, patients can expect specific post-operative care and considerations. Monitoring for any signs of complications, such as infection or excessive bleeding, is essential. Patients may experience some discomfort or pain at the incision site, which can be managed with prescribed pain relief medications. Follow-up appointments will be necessary to assess healing and the success of the reimplantation. Additionally, patients should be counseled on the potential for future pregnancies and any necessary lifestyle adjustments or fertility treatments that may be required. Overall, the recovery process will vary among individuals, and adherence to post-operative instructions is crucial for optimal outcomes.