Microsurgery

Microsurgery is surgery done under magnification, with fine tools and delicate stitches, on small or fragile structures.¹ The surgeon uses magnifying lenses (loupes) or an operating microscope. In reproductive surgery, its principles include low tissue damage and careful control of bleeding. They also include joining cut ends without tension, and careful closure, one layer at a time.

Microsurgery is central to tubal ligation reversal. Joining the two cut ends of the fallopian tube requires alignment at the millimeter scale. It is equally central to vasectomy reversal. There, the opening of the vas deferens may be less than one millimeter across.

The same fine technique guides the careful handling in near adhesion-free reconstructive pelvic surgery. There, gentle handling of tissue directly affects how much scar tissue forms afterward.

A 2023 systematic review and meta-analysis looked at more than 14,000 patients. After the tube was rejoined, the pooled pregnancy rate was 65.3% (95% CI 61.0 to 69.6). The live birth rate was 42.6%. The review found the same outcomes with open surgery, a scope or a robot.

The same analysis found that reversal did better than in vitro fertilization for women over 35.¹ Earlier studies of past patients report lasting results.²³ The patient's age at reversal is the single strongest factor in the outcome. The surgeon's experience and the length of tube left after reversal are the main technical factors.