The uterus has three structures attached to it near the cornu on each side, the round ligament in front, the fallopian tube in the middle, and the uteroovarian ligament behind. All three appear tubular (though only the fallopian tube is truly tubular, the other two are solid inside). One of them may be confused for any of the others, if the operative field is very small, as in tubal ligation during puerperium or during a minilaparotomy. Ligation of any of the two ligaments instead of the fallopian tube is a not infrequent cause of failure of female sterilization.
Usually this mistake is made by a junior resident doctor in training. He/she has to be reminded to trace the structure held laterally to see if it ends in fimbriae. If it does, it is truly the fallopian tube. During laparoscopic sterilization, it is often not possible to trace the tube laterally to see the fimbriae, because one performs it under local anesthesia (except in teaching hospitals) and insertion of multiple instruments is not possible. A rule of thumb is to visualize three tube-like structures at the cornu, the middle of which is the fallopian tube. If a person ranking higher than a resident doctor in training confuses something else for the fallopian tube, there is indeed good reason to get worried.
"Hey, look at the fallopian tube" exclaimed the Professor and Head of the unit while performing a laparoscopic sterilization. The fact that such a distinguished person found something different about a fallopian tube should suggest it was indeed different. I was a much junior person at that time. I put my eye to the eyepiece of the telescope.
"It is funny. It is curved and going to the internal inguinal ring" the Professor said.
The description was quite diagnostic and there was actually no need to look. It had to be the round ligament. I was already looking anyway and continued to do so as asked.
"There is another fallopian tube behind the one you have found" I declared politely after a respectable time interval. "That looks like a normal fallopian tube."
The Professor took charge of the laparoscope, looked inside, and ligated the tube without saying a word.
This must have been one of the many reasons the Professor considered me an enemy. I could have exclaimed "indeed it is an unusual fallopian tube" and allowed the Professor to ligate it. I would not have caused any feelings of enmity that way. I could not do it because I could not allow the poor woman to get pregnant due to ligation of a wrong structure.
I thought of this story after many years, when I saw another senior person (not as senior as that Professor though) make the same mistake the other day.
Usually this mistake is made by a junior resident doctor in training. He/she has to be reminded to trace the structure held laterally to see if it ends in fimbriae. If it does, it is truly the fallopian tube. During laparoscopic sterilization, it is often not possible to trace the tube laterally to see the fimbriae, because one performs it under local anesthesia (except in teaching hospitals) and insertion of multiple instruments is not possible. A rule of thumb is to visualize three tube-like structures at the cornu, the middle of which is the fallopian tube. If a person ranking higher than a resident doctor in training confuses something else for the fallopian tube, there is indeed good reason to get worried.
"Hey, look at the fallopian tube" exclaimed the Professor and Head of the unit while performing a laparoscopic sterilization. The fact that such a distinguished person found something different about a fallopian tube should suggest it was indeed different. I was a much junior person at that time. I put my eye to the eyepiece of the telescope.
"It is funny. It is curved and going to the internal inguinal ring" the Professor said.
The description was quite diagnostic and there was actually no need to look. It had to be the round ligament. I was already looking anyway and continued to do so as asked.
"There is another fallopian tube behind the one you have found" I declared politely after a respectable time interval. "That looks like a normal fallopian tube."
The Professor took charge of the laparoscope, looked inside, and ligated the tube without saying a word.
This must have been one of the many reasons the Professor considered me an enemy. I could have exclaimed "indeed it is an unusual fallopian tube" and allowed the Professor to ligate it. I would not have caused any feelings of enmity that way. I could not do it because I could not allow the poor woman to get pregnant due to ligation of a wrong structure.
I thought of this story after many years, when I saw another senior person (not as senior as that Professor though) make the same mistake the other day.
