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  • Title: Tubal sterilization by lararoscopy. Simplified technique.
    Author: Singh KB.
    Journal: N Y State J Med; 1977 Feb; 77(2):194-6. PubMed ID: 138805.
    Abstract:
    A method of laparoscopic tubal sterilization which has been proven to be simple, safe, and effective in over 1000 patients is described. General anesthesia has usually been used. After the usual preparations, a Semm uterine probe connected with an 80-100 mm of Hg suction is inserted into the uterus for subsequent manipulation. A Veress needle is inserted and 2-3 liters of carbon dioxide gas insufflated into the abdomen. A trocar and cannula are then inserted through an 8 mm intraumbilical incision. A single-incision technique is used. In obese patients, a suprapubic route may be selected. Body weight over 300 pounds is a contraindication. The 170-degree, 10 mm Palmer-Jacobs operating laparoscope with 5.5 mm fibrooptic bundle is inserted into the cannula. A routine survey of the pelvis is made 1st. The insulated grasping forceps, as active electrode, is then introduced into the operating channel. Once identified, each tube is grasped at 2-5 cm from the cornual end, avoiding prominent blood vessels. Coagulation of a small segment of each tube is done without coagulation of the mesosalpinx. Severing of the tubes is done mechanically by push-pull leverage. Blood loss is minimal. Chances of inadvertent bowel burns are reduced due to short duration of RF current use. To use RF current for cutting or severing tubes may injure blood vessels and extensive tissue damage may lead to flare-up of pelvic inflammatory disease. Subsequent tubal patency tests have not been needed. The separated segments of the tubes are protected from mucosal spread of any endometrial infection. Appropriate tubal reconstruction surgery is favored in selected patients. Tubal specimens removed have usually shown good morphological details.
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