Pregnancy Outcome in Microsurgical Anastomosis Using Cold Knife Versus CO2 Laser

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Abstract
It is well accepted that proper microsurgical techniques (which include gentle handling of tissues, precise aposition, and constant irrigation) improve pregnancy success rates in tubal reanastomosis. In order to evaluate an additional factor (the mode of excision of the occluded portions) in microsurgical tubal reanastomosis, we evaluated retrospectively two groups of patients to determine whether the CO2 laser or the cold knife as the surgical cutting instrument could improve pregnancy rates. Group I (18 patients) had excision of the obliterated ends with the cold knife, and group II (45 patients) had excision with high power density CO2 laser. All patients had an infertility evaluation before surgery, consisting of a postcoital test, hysterosalpingogram, timed endometrial biopsy, Ureaplasma urealyticum culture, and husband's semen analysis. Thirteen of 18 patients (72.2%) in group I conceived versus 27 of the 45 patients (60%) in group II. In this study, the use of the CO2 laser showed lower but not statistically significant pregnancy rates than did cold knife. Less bleeding and decreased operating time were associated with the use of the CO2 laser. (J GYNECOL SURG 5:99, 1989)

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