The success rate of tubal anastomosis, measured as the rate of intrauterine gestations after surgery, is generally quite high, especially if there is an appropriate patient selection and evaluation prior to surgery. Laparoscopic technique of tubal anastomosis was developed in 1998 after many years of performing minilaparotomy and traditional microsurgery in several hundred cases. A specially designed, malleable, tubal cannulator is introduced through the cervix and guided to the proximity of the tubal ostia under laparoscopic control. The stent facilitates the performance of the laparoscopic tubal anastomosis tremendously. The laparoscopic approach is essentially identical to that of the open-abdomen technique except for the use of specialized instrumentation to facilitate its performance via laparoscopy. A proper preoperative evaluation of the ovarian reserve and male factor are important determinants as to whether the patient will be best served by having a laparoscopic tubal anastomosis or in vitro fertilization.