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  • Title: Method of sterilization is important choice for patient.
    Journal: Contracept Technol Update; 1984 Feb; 5(2):17-8. PubMed ID: 12265921.
    Abstract:
    Family planning professionals should advise their female sterilization patients regarding which sterilization techniques are most popular, the most effective, and the safest. Dr. Albert Yuzpe stated during a recent family planning conference in Atlanta that physicians use 3 means of reaching the fallopian tubes: abdominal, vaginal, and transcervical. The 2 most popular methods of abdominal tubal ligation are the minilaparotomy and the laparoscopy, according to Yuzpe. He claims that the minilaparotomy, which is performed as a postpartum or a nonpregnancy associated procedure, is both the most effective and best sterilization method for patients in developing countries. Highly specialized training and sophisticated equipment are needed for laparoscopy by endoscope. Yuzpe maintains that neither conventional laparotomy nor hysterectomy should be performed purely for the sake of permanent contraception, indicating that "it is very difficult to condone the use of laparotomy for simple tubal ligation." Regarding vaginal methods, Yuzpe said the complication rate with vaginal surgery is greater than with other methods. Vaginal sterilization is generally performed by posterior or anterior culpotomy, but the anterior method is usually reserved for patients undergoing midtrimester pregnancy termination. The transcervical approach involves a more specialized endoscopic technique where the hysteroscope is use for direct visual examination of the cervical canal and uterine cativy. After the surgeon reaches the fallopian tubes, he or she has to determine what method to use to close off the tubes. According to Yuzpe, the method of closure dictates the efficacy of the procedure. Historically, clinicians have used the following types of closures: bipolar electrocoagulation; electrocoagulation plus transsection; thermocoagulation; and mechanical occlusive methods. Every method, states Yuzpe, involves some chance of failure. He advises that the best thing a clinician can do is help a patient select a method of sterilizatin that affords the best protection against pregnancy but has some potential for reversibility, even if reversibility is not discussed with the patient.
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