Laparoscopy for Tubal sterilization
Tubal sterilization can be performed within 72 hrs of completion of a vaginal delivery. If it is performed at other times it is called interval sterilization.
Local anesthesia is used for more than 75% of sterilizations worldwide. Laparoscopic sterilization in performed under general anesthesia. Spinal anesthesia is preferred for procedures done immediately after delivery of the baby. Local anesthesia is the standard for the hysteroscopic approach, and it may be supplemented by oral or IV sedation if needed.
The actual procedure is done in an operating room, either in a hospital or a surgical center.
Currently, Laparoscopy is the most popular method of female sterilization in nonpregnant women. It is performed under General Anesthesia. The surgery takes about half an hour.
1. In the Laparoscopy procedure, the abdomen is filled with carbon dioxide gas by introducing a needle so that the abdominal wall balloons away from the uterus and tubes.
2. The surgeon makes a small cut just below the navel and inserts a laparoscope, a small telescope-like instrument.
3. A second incision is made just above the pubic hairline to allow the entrance of another small instrument that can help with closure of the fallopian tubes.
4. Usually Falope rings or Filshie clips are placed on the fallopian tubes to block the tubes. Sometimes the tubes are cut and clipped
5. The skin incision is then closed with one stitch or a tape. The patient may feel well enough to go home from the outpatient surgery center in a few hours.
Advantages include small incisions, rapid access to the fallopian tubes and rapid recovery.
Disadvantages include the need for general anesthesia, the risks of injury to internal organs with needle insufflations. Difficulty associated with Laparoscopy in patients who are obese.
Micro-laparoscopy involves use of micro endoscopes of smaller diameter with 5 to 7 mm suprapubic incisions being made. This surgery is possible because of improved technology in light transmission and fiber optic bundles.
There are some theoretical advantages such as even smaller scars, less pain, less cost, and faster patient recovery. However the difference is so marginal that it has never become very popular despite being available for almost 20 years.
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