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July 16, 1982

Principles of Microsurgical Techniques in Infertility

JAMA. 1982;248(3):374. doi:10.1001/jama.1982.03330030072043

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Microsurgery is an art form as well as a science. Its practitioners are opinionated, often with a paucity of objective evidence to support strongly held contentions. Thus, it is not surprising that this work by 14 contributors has many areas of disagreement, and, more unfortunately, redundancies.

The most lucid chapters are those by Eddy on tubal physiology and Stangel on instrumentation. In the clinical chapters we are exhorted to avoid use of Babcock clamps on pelvic structures in one place, but find diagrams in which traction is exerted by this instrument in others. Some authors stress the importance of reperitonealization, while others interdict it (in italics!) without citing the basic research supporting either view. One author decries reversal of fimbriectomy sterilization, while another cites from the literature a 44% pregnancy rate success.

The chapter on patient selection deals with reported success rates for various procedures. Comparison of 1,037 macrosurgical implantations