Laparoscopic tubotubal anastomosis: laparoscopic microsurgery in gynecology.

Tubotubal anastomosis technique dates back to the 1920's when large sutures were used to approximate proximal and distal ends of the fallopian tube. Direct vision, aided by overhead illumination, was used and stitches were placed superficially to avoid inclusion of the posterior wall. Delicate tissue handling was not stressed. No major breakthroughs in this area developed over the next half century. The 21% success rate for the conventional technique was disappointingly low although a clear explanation has never been established. Presumably it was caused either by the failure to reconstruct a patent lumenal channel or by causing extensive postoperative adhesion formation.