Laparoscopic tubal

sterilization
 Background & Indications
Permanent but reversible interruption of the
oviducts to prevent pregnancy has been a
surgical goal since the 19th century.
By the early 1970s, 95% of tubal sterilization in
USA were done using a high frequency
monoplar coagulation through laparoscopic
technique.
High failure rate, led to the development of the
bipolar high frequency coagulation.
Non-coagulative techniques, suture, clips and
silastic bands.
The failure rate of clips sterilization is also
higher.
Large studies report a four failure in 1000
procedure.
Tubal pregnancy is more in patients who
become pregnant after tubal sterilization.
The success rate of tubal reanastomosis
depends
Coagulation sterilization
 Procedure
Most of the laparoscopic method of sterilization
are performed using two sheaths, one for the
telescope in umblicus, and the second in the
midline 5 or 10 mm.
Single-puncture technique…
Several anaesthetic technique are appropriate
for laparoscopic tubal sterilization, including
general, regional and local.
Local anaesthesi is sutable for the single-
puncure technique, which lasts for 10 minute.
Bipolar high-ferquency coagulation is the most
commonly used technique…description
Failure rate of the bipolar method ranges from 4-
7 per 1000.
Failure rate rises up to 50 per 1000 if single site
coagulation is used.
Semm described a similar technique with a
single site coagulation with transection.
He reported pregnancy rate of 2 per1000.
Ligation and resection technique has a failure
rate of 5 per 1000.
Pomeroy advocate using absorbable sutures.
Yoon developed the Falope-Ring applicator.
Simple and can be done through single-puncture
technique under local anesthesia.
Complications are, bleeding, pain and
incomplete occlusion.
Failure rate ranges from1-38 per 1000.
Tubal reanastomosis is difficult later because of
necrosis of long segment of tube.
Clips like Tantalum clips were tried
initially.
Hulka introduced a plastic clip with gold-
plated spring to maintain clipping.
This technique permit future
reanastomosis and has a failure rate of 6
per1000.