INTRODUCTION Tubal diseases are one of the frequent causes of infertility. The most common predisposing factor is pelvic inflammatory disease (PID). Distal tubal obstruction has been managed previously by open surgery using microsurgical technique. The pregnancy rate after reconstructive surgery is 20–30% 2 years postoperatively. Laparoscopy for tubal infertility has been a significant factor in reducing—costs, hospitalization, and recuperation. Recently, in women with severe tubal damage, in vitro fertilization (IVF) offers a better chance for term pregnancy (72.3%) compared to reconstructive surgery (27.3%). Fimbrioplasty and lysis of peritubal and periovarian adhesions have been associated with good pregnancy rates. In these patients, IVF is appropriate when pregnancy is not achieved postoperatively after a few years. LAPAROSCOPIC TUBAL ANATOMY The fallopian tubes arise from the superior portion of the uterus just above the attachment points of the round ligament. Laparoscopically, the round ligaments overhang the fallopian tube because of uterine manipulation and can be easily mistaken for them. The fallopian tubes toward its lateral end encircle the ovaries partially with their fimbriated ends (Fig. 1) . Fig. 1: Tubal anatomy. Laparoscopic Tubal Surgery From anterior to posterior, following important tubular structures are found crossing the brim of true pelvis; the round ligament of the uterus, the infundibulopelvic ligament, which contains the gonadal vessels and the ureter. The ovaries and fallopian tube is found between the round ligament and the infundibulopelvic ligament. The ovarian ligaments run from the ovaries to the lateral border of the uterus. Ovary is attached to the pelvic side wall with infundibulopelvic ligament, which carries ovarian artery. One of the common mistakes that a surgeon can land into is injury of the ureter during dissection of the infundibulopelvic ligament. If the uterus is deviated to the contralateral side with the help of uterine manipulator, infundibulopelvic ligament is spread out and a pelvic side wall triangle is created. The base of this triangle is the round ligament, the medial side is the infundibulopelvic ligament, and the lateral side is the external iliac artery. The apex of this triangle is the point at which the infundibulopelvic ligament crosses the external iliac artery. The ureters enter the pelvis in close proximity to the female pelvic organs and are at risk for injury during laparoscopic surgery of these organs. As the ureter courses medially over the bifurcation of the iliac vessels, they pass obliquely under the ovarian vessels and then run in close proximity to the uterine artery. Patient Position Patient should be in steep Trendelenburg’s and lithotomy position. One assistant should remain between the legs of patient to do uterine manipulation whenever required. Port Position Port position should be in accordance with baseball diamond concept. If the left side of tube has to be operated, one port should be in right iliac fossa and another below left hypochondrium (Fig. 2) . Prof. Dr. R. K. Mishra