Carbon dioxide laser tissue welding: an alternative technique for tubal anastomosis?

Microsurgical tubal anastomosis is the gold standard for treatment of tubal occlusion. The present study was performed to establish the feasibility of tubal anastomosis by welding tissue with a defocused CO2-laser beam during laparotomy and with an endoscope. In an animal experiment, 70 white New Zealand rabbits were randomized in 2 study groups (E1, E2) and 3 control groups (C1, C2, C3) as follows: C1, 10 animals, no operation, as controls for the efficiency of the insemination technique; C2, 5 animals, spontaneous healing after tubal segment resection, to quantify spontaneous recanalization of the tube; C3, 15 animals, microsurgical end-to-end adaption after tubal segment resection; E1, 20 animals, laser welded anastomosis after segment resection via laparotomy; E2, 20 animals, laparoscopic laser welded anastomosis after segment resection. The pregnancy rate in C1 was 80%. None of the animals in C2 but 60% of the rabbits in C3 conceived. After sutureless anastomosis by laser welding 50% of the laparotomized, and 40% of the laparoscopically operated group became pregnant. Morphological examination of the oviducts after relaparotomy showed comparable patency rates of 70% in C3, 70% in E1, and 65% in E2. Whereas no dehiscence of anastomoses was observed in C3, 20% of the welded tubes in E1 and 22.5% in E2 were dehiscent. Tubal anastomosis took approximately three times as long laparoscopically as during laparotomy. Thus, laser welding as a sutureless alternative technique of tubal anastomosis should be viewed critically. A reduction of sutures through laser-assisted anastomosis might, however, be considered.