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A method of keeping fallopian tubes open
A :METHOD OF KEEPING FALLOPIAN TUBES OPEN BY WrrjLIAM
T: KENNJWY, M.D., NEw YoRK, N. Y. INTRODUCTIO::-<
insufflation of the fallopian tubes with C0 gas as done by T HE Rubin has led to the detection of obstructions which produce ste2
1
rility. After the diagnosis of occluded tubes has been established and there is no evidence of acute or subacute salpingitis, a laparotomy is done, adhesions about the fimbriae of the tubes are separated, and a resection of either tube is done when necessary. Some material is now required to preserve the patency of the tubes. Huber 2 experimentally has observed the superiority of alcoholized tissue in nerve surgery. For some time I have used Cargile membrane hardened in alcohol for at least 48 hours, threading it through the fallopian tubes and the cavity of the uterus to keep these tubes open both into the uterine cavity and into the peritoneal cavity. The membrane is flexible and strong, nonirritating to the contact tissues and is slowly absorbed, giving all raw surfaces time to heal and allowing this part of the genital tract to remain patent. TECHNIC
The accompanying diagram (Fig. 1) illustrates the apparatus used and the method of procedure . .ll.
.B.
=======-'c·=========== :n.
u. Fig. 1.-A, silver probe-length about 10 em.; diameter .75 mm. to 1.00 mm., having a bristle about .45 mm. in diameter mounted in one end. B, cannula-to attach a Luer hypodermic syringe at one end and a hollow probe C at the other. C, hollow siiver probe--length about 25 em., diameter the same as A. D, strand of piano wire-about 3 em. longer than
C, looped at one end to serve as a meinbrane carr:ier.
E, strip ·of Cargile membrane about
40 em. long and 3 em. wide. F, Fallopian tubes. U, uterus. 0, ovary. F!. . round ligament. T, point of attachment of one end of the membrane. S~ plastic sutures to anast01nose the exci::;~ed ends after a resection.
607
608
THE AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
The Pro be ..J.. is passed down the :fallop:ian Cfl.na.L The bristle enters :first the .isthmus of the tube, then the uterine cavity, directs the probe and makes the canal large enough to allow the passage of Probe C. Probe A is now removed and used to treat the other tube in the same manner. If there are any signs of an old inflammatory process each fallopian tube can be slowly irrigated from the :fimbria into the uterine cavity with alcohol, using the Luer syringe attached to B and C. If for any reason the resection of a part of either tube is found necessary, that should now l:e done. Then thread Probe 0 through one fallopian tube, the cavity of the uterus, and the other fallopian tube as illustrated. Insert and tie a11 plastic sutures, S with 0 in position, to eliminate any possible obliteration of the canal. Now insert D into C and thread E on the wire loop, withdraw C, D and E together and leave the membrane through this part of the genital tract. Thread one encl of the membrane on a round needle, pass it through the portion of the broad ligament at T and ligate it. Fasten the other end in the same manner to the other broad ligament at T. This will leave a loop of the membrane in the peritoneal cavity at each side to accommodate a possible pregnancy before the membrane becomes absorbed.
All cases diagnosed as acute or subacute salpingitis must wait at least six months and the treatment of any such cases not suspected on diagnosing, but so found by laparotomy, n1ust be postponed. The pro~ cedure takes from 10 to 30 minutes. Accessory, malposition and other pathological conditions are treated when indicated. REFERE~CES
(1) Jour. Am. J'\Ied. Assn., l:s:..'>:v, 661. Am. Jour. Roentgen., March, 1921, p. 120. (2) Surg., Gynec. and Obst., May, 1920, p. 464. 163 EAST SIXTY·FIRST
STREET.
T: KENNJWY, M.D., NEw YoRK, N. Y. INTRODUCTIO::-<
insufflation of the fallopian tubes with C0 gas as done by T HE Rubin has led to the detection of obstructions which produce ste2
1
rility. After the diagnosis of occluded tubes has been established and there is no evidence of acute or subacute salpingitis, a laparotomy is done, adhesions about the fimbriae of the tubes are separated, and a resection of either tube is done when necessary. Some material is now required to preserve the patency of the tubes. Huber 2 experimentally has observed the superiority of alcoholized tissue in nerve surgery. For some time I have used Cargile membrane hardened in alcohol for at least 48 hours, threading it through the fallopian tubes and the cavity of the uterus to keep these tubes open both into the uterine cavity and into the peritoneal cavity. The membrane is flexible and strong, nonirritating to the contact tissues and is slowly absorbed, giving all raw surfaces time to heal and allowing this part of the genital tract to remain patent. TECHNIC
The accompanying diagram (Fig. 1) illustrates the apparatus used and the method of procedure . .ll.
.B.
=======-'c·=========== :n.
u. Fig. 1.-A, silver probe-length about 10 em.; diameter .75 mm. to 1.00 mm., having a bristle about .45 mm. in diameter mounted in one end. B, cannula-to attach a Luer hypodermic syringe at one end and a hollow probe C at the other. C, hollow siiver probe--length about 25 em., diameter the same as A. D, strand of piano wire-about 3 em. longer than
C, looped at one end to serve as a meinbrane carr:ier.
E, strip ·of Cargile membrane about
40 em. long and 3 em. wide. F, Fallopian tubes. U, uterus. 0, ovary. F!. . round ligament. T, point of attachment of one end of the membrane. S~ plastic sutures to anast01nose the exci::;~ed ends after a resection.
607
608
THE AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
The Pro be ..J.. is passed down the :fallop:ian Cfl.na.L The bristle enters :first the .isthmus of the tube, then the uterine cavity, directs the probe and makes the canal large enough to allow the passage of Probe C. Probe A is now removed and used to treat the other tube in the same manner. If there are any signs of an old inflammatory process each fallopian tube can be slowly irrigated from the :fimbria into the uterine cavity with alcohol, using the Luer syringe attached to B and C. If for any reason the resection of a part of either tube is found necessary, that should now l:e done. Then thread Probe 0 through one fallopian tube, the cavity of the uterus, and the other fallopian tube as illustrated. Insert and tie a11 plastic sutures, S with 0 in position, to eliminate any possible obliteration of the canal. Now insert D into C and thread E on the wire loop, withdraw C, D and E together and leave the membrane through this part of the genital tract. Thread one encl of the membrane on a round needle, pass it through the portion of the broad ligament at T and ligate it. Fasten the other end in the same manner to the other broad ligament at T. This will leave a loop of the membrane in the peritoneal cavity at each side to accommodate a possible pregnancy before the membrane becomes absorbed.
All cases diagnosed as acute or subacute salpingitis must wait at least six months and the treatment of any such cases not suspected on diagnosing, but so found by laparotomy, n1ust be postponed. The pro~ cedure takes from 10 to 30 minutes. Accessory, malposition and other pathological conditions are treated when indicated. REFERE~CES
(1) Jour. Am. J'\Ied. Assn., l:s:..'>:v, 661. Am. Jour. Roentgen., March, 1921, p. 120. (2) Surg., Gynec. and Obst., May, 1920, p. 464. 163 EAST SIXTY·FIRST
STREET.