LAPAROSCOPIC STERILIZATION

Abstract

28 English language sources and results from 300 consecutive laparoscopic sterilizations are reviewed. General anesthesia with muscle relaxation and endotracheal intubation is used. With a Verres cannula inserted below the umbilicus 3 to 4 liters of carbon dioxide are introduced into the peritoneal cavity. A trocar and cannula are introduced through a 1-cm transverse subumbilical incision. Then the trocar is removed the laparascope is passed through the cannula into the peritoneal cavity and the uterus is visualized. Palmer coagulation forceps introduced adjacent to the laparascope are used to grasp each Fallopian tube in turn. Final steps are coagulation of a 3-cm length of tube adjacent to the uterus division of the cauterized portion of tube by a cutting attachment incorporated in the forceps removal of instruments expulsion of gas and closure of incision with 2 sutures. Complications (none permanent) in the 300 cases included introduction of carbon dioxide into the preperitoneal space (6) emphysema of the greater omentum (5) hypotension (1) and postoperative fever (4). Obesity prevented laparascopy in 1 case. Other complications of gynecological laparoscopy are extrasystole perforation of stomach or intestine and intraperitoneal hemorrhage. Out of 5279 laparoscopic sterilizations performed there were only 12 failures at least 6 due to inexperienced operators: 9 intrauterine and 3 tubal pregnancies (0.23%) occurred. Advantages of laparoscopic sterilization include little pain postoperatively cosmetic benefit of small incision which associates with the umbilicus and short hospital stay (36 hours) and home convalescence (less than a week).