Robotic approach to tubal reanastomosis has gained widespread popularity because of the ease of suturing compared to traditional laparoscopy. More specially, improved ergonomics, magnified and superior visualization, stable camera and wristed articulating instrumentation without tremor, make robotic approach uniquely suitable for tubal anastomosis. Falcone et al. [1] initiated the first robotic tubal reanastomosis using the Zeus robotic surgical system (Computer Motion, Goleta, CA, USA) in 1999, and reported a pregnancy rate of 50%. Throughout the 2000s, Caillet et al. [2] continued to perform tubal reanastomosis using robotics, and reported significant improvements in pregnancy rates, ranging from 63% to 71%, through multiple cases. In 2019, Guan et al. [3] conducted the first case of robot-assisted single-site tubal reanastomosis.
Our objective is to demonstrate the benefits of performing tubal reanastomosis using a single port through the umbilicus with the Da Vinci Xi robotic system (Intuitive Surgical, Sunnyvale, CA, USA). Furthermore, we aim to enhance the accessibility of robotic tubal reanastomosis in the future. This procedure not only simplifies the surgical method but also has the advantage of minimizing the incision site, providing benefits from an aesthetic perspective.
We present the case of a 41-year-old woman, gravida 2 para 2 (2 Cesarean sections), with a history of tubal ligation during her last Cesarean section. The patient opted for tubal reanastmosis as a first-line procedure rather than in vitro fertilization. Another finding was the presence of a 5 cm left ovarian cyst and localized adenomyosis (R/O myoma) observed on ultrasound. We performed robotic single-site tubal reanastomosis and left ovarian cystectomy on the patient. Proximal and distal opening of the salpinx was created with cold scissor and monopolar hook. The mesosalpinx was sutured with 6-0 polydioxanone (PDS) suture and then the mucosal layer was sutured with 4 interrupted 6-0 PDS sutures using two wristed needle drivers.
After successful tubal reanastomosis, chromopertubation with indigocarmine was injected, and the patentcy was confirmed. The operative time of tubal reanastomosis was approximately 150 minutes, resulting in a successful surgery. The patient was admitted for observation and discharged home on postoperative day 1. There was no postoperative complication. The postoperative hysterosalpingography (HSG) was not performed as the patient did not want to check HSG.
Our experience shows that the robot-assisted single-site surgery is an effective and feasible surgical technique for enhancing accessibility in tubal reanastomosis. The advantage of using the Da Vinci Xi system is that it enables more precise surgery with increased range of motion and versatility, utilizing thin arms for very simple maneuvers. Our video demonstrates the feasibility and safety of robot-assisted surgery, proving reduced blood loss and shorter hospital stays.
Many studies have shown that the pregnancy success rates for laparoscopic and laparotomy tubal reanastomosis are similar, and that robotic surgery shows little to no decrease in pregnancy rates (50–71%) [4-6]. However, further research with continuous follow-up and more cases are needed to better understand the pregnancy outcomes. Accumulating more clinical experience with robotic singlesite surgery could provide an alternative method for tubal reanastomosis.
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