The Brigham and Women’s Hospital (BWH) Center for Infertility and Reproductive Surgery is a world leader in using state-of-the-art robotics to improve reproductive surgery outcomes. This advanced technology’s potential to expand the scope of minimally invasive (laparoscopic) surgery and shorten patient recovery time is motivating more and more of our patients to consider robotic tubal sterilization reversal as a safe and effective means of restoring their fertility.
A tubal sterilization reversal – also known as tubal ligation reversal, tubal reanastomosis or, more simply, tubal reversal – is a surgical procedure to restore a woman’s fertility after she has had her “tubes tied” (tubal ligation). During a tubal ligation, a surgeon severs both fallopian tubes and then seals the segment openings by cauterizing, clamping or banding them shut. To reverse this procedure, the surgeon opens the blocked end of each tube segment and then reconnects the separated segments.
Robotic tubal sterilization reversal uses a combination of high-definition 3D magnification, robotic technology and miniature instruments to enhance a reproductive surgeon’s skills when reconstructing a woman’s fallopian tube.
Antonio R. Gargiulo, MD, Director of Robotic Surgery, Division of Reproductive Medicine, and Serene Srouji, MD, Associate Director of Robotic Surgery, Division of Reproductive Medicine, have been using the FDA-approved da Vinci® Surgical System to perform robotic tubal reversals at BWH since 2007. The system consists of a surgeon’s console, equipped with a control panel and a hi-definition monitor, and a patient side-cart, outfitted with slender robotic arms and attended by another surgeon and a nurse.
Only tiny incisions in the abdomen are required for the slender robotic arms and tiny surgical tools used in a robot-assisted tubal ligation reversal. There are four available arms, which are all wristed – one equipped with a high definition 3-D magnification camera, two that act as the surgeon’s arms and an optional arm that can be used for holding back tissue. The camera gives the surgeon enhanced detail, true depth of field and a panoramic view, and the robotic hands’ broad range of movement enables greater dexterity. This enhanced visualization, precision, and dexterity provide significant advantages when delicately reconstructing the fallopian tube, thereby helping to safely restore fertility.
These capabilities are further enhanced by the surgical console’s unique ergonomics that help ease surgeon fatigue and mechanics that enable steady movements. The surgeon remotely guides the robotic arms while seated at the console, located a short distance away from the patient. These smooth and effortless movements, along with the wristed capabilities of the robotic arms, are the most significant advantages that robotic surgery has over traditional minimally invasive surgical procedures.
Robotic surgery’s miniaturization, increased range of motion, enhanced vision and mechanical precision offer significant benefits for our reproductive surgery patients, including:
Antonio R. Gargiulo, MD and Serene Srouji, MD launched BWH’s Robot-Assisted Reproductive Surgery program when they performed New England’s first successful robot-assisted laparoscopic tubal sterilization reversal in January 2007. Shortly thereafter, in February 2007, they also performed Boston’s first robot-assisted hybrid myomectomy for the removal of very large fibroids (myomata). They have since continued this accomplished partnership to perform more than 400 robot-assisted surgeries at BWH. In addition to tubal sterilization reversal and myomectomy, Drs. Gargiulo and Srouji use the robot to perform other types of complex laparoscopies, such as procedures to remove pelvic endometriosis. Drs. Gargiulo and Srouji also are leading advocates of the technology, regularly teaching robotic procedures to physicians from throughout the world.
If you would like to schedule a consultation with Dr. Gargiulo or Dr. Srouji, please call the Patient Referral Service - staffed 8am - 5:30pm, Monday through Friday - at 1-800-294-9999, or fill out an online appointment request form.
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