There are two different types of reversal surgery, the ‘open’ reversal and the ‘laparoscopic’ (AKA ‘keyhole’) reversal of female sterilisation surgery. Since the introduction of female sterilisation as a contraceptive option, almost all reversals have been done ‘open’, through a small cut in the lower tummy (around where a caesarean section cut would be).

(Warning, images taken at surgery of the inside of the tummy below.)

Open Reversal Surgery

The ‘open’ female sterilisation reversal procedure is a well-established procedure. Due to this, most data regarding pregnancy success rates following reversal are collected from this open procedure. In the case of the Nottingham female sterilisation reversal clinic, which has performed hundreds of open reversals over more than a decade, around 65-70% of patients have managed to conceive naturally following open reversal.

Including anaesthetic time, open surgery takes around two hours to complete and whilst some patients do go home the same day, most patients stay one night in hospital. The cut tends to heal in a couple of weeks and the scar, which is hidden below the bikini line, generally starts to fade within 2-3 months (see figure 1 below, at 2-3 months post-op). The cut is around 2.5-3 inches long. Whilst the cut does result some degree of discomfort, patients are up and out of bed within only a few hours of the operation.

Patients can often return to work soon after the operation too, with some returning to work after only a week! It is not, however, unreasonable to have 2-4 weeks off work. Especially if it is a strenuous job.

The success of this procedure relies on the skills of the surgeon, requiring training in microsurgical techniques and the use of microsurgical instruments. In general, this type of reversal procedure is suitable for most patients.

Keyhole surgery

The keyhole reversal of female sterilisation surgery is a relatively new procedure, offered by only a handful of surgeons globally. Unlike an open reversal, it is performed through 4 much smaller cuts on the tummy. The cuts are generally less than 1 cm in size and are located on the lower left and right of the tummy, low down in the middle of the tummy just below the bikini line and in the tummy button.

Keyhole reversal surgery requires a much higher degree of surgical skill and dexterity than open reversal surgery and even normal keyhole surgery for other gynaecological reasons. This is because a keyhole reversal involves the extremely delicate handling of fragile tubal tissue with special smaller keyhole surgical instruments. In addition to this, the stitching and knot tying is done inside the tummy using very fine sutures, which requires a lot of practise!

Due to the increased complexity, the surgery takes considerably longer, often lasting 2-3 hours. As such this type of reversal surgery does carry a slight increase in cost. Whilst pregnancy success rates are probably the same when compared to open surgery, we don’t yet have the same number of cases to demonstrate this.

The benefits of keyhole surgery, over open surgery, are:

  • The patient can potentially go home just a few hours later.
  • There is less post op discomfort.
  • There is a lower chance of developing scar tissue and adhesions within the tummy.
  • Recovery is quicker.

Keyhole reversal is an option for most women, however due to the increased complexity it is better suited to women who have never had a caesarean section or surgery in their tummy, carry a BMI less than 30 and who have had Filshie clip sterilisation. That’s not to say it cannot be considered in other situations. If you are interested, we recommend discussing this with Mr Dobson, who after taking a thorough medical and surgical history can advise you on which type of reversal will give you the best chance of a pregnancy.

How is keyhole surgery performed?

There are several steps to a keyhole reversal. The image below (figure 2) shows the pelvis, prior to reversal surgery, viewed from a keyhole camera placed in the tummy button. You can see the uterus (womb) in the middle and the ovaries (white) below the uterus.

On both sides of the uterus you can see the tubes are not connected in their middle portion. This is more subtle on the right tube but can be clearly seen in the left. Where the left tube is separated, the farthest bit of tube from the uterus is even stuck to the abdominal wall via some flimsy adhesions.

Just above the left tube you can see two dark grey ‘Filshie clips’ which have migrated off the tubes to sit in front of the womb (this is normal and nothing to worry about). The yellow bit at the bottom of the image is the normal fatty tissue that sits around the bowel.

keyhole female sterilisation reversal

After the clips have been removed from the abdomen, Mr Dobson has then carefully separated the adhesions and cut the scar tissue off the ends of the tubes where they were previously joined together. Following this he has aligned the inside of the fallopian tubes together with a carefully placed stitch and then proceeded to place several laparoscopic stitches around the circumference of each tube to join them together.

The result, with both tubes now repaired and connected, can be seen in the zoomed in images of the tubes in figures 3 and 4.

keyhole reversal of female sterilisation surgery

We hope this has been helpful. As we have said above, if you are interested in having a reversal of female sterilisation, please do get in touch with us on 0115 966 2111 or email Mandy Banbury (PA to Mr Dobson).