Pregnancy following laparoscopic tubal electrocoagulation and division.

In a series of 3160 sterilization procedures performed by laparoscopic electrocoagulation and division, 16 pregnancies were reported. 9 of these failures were attributable to surgical error, for a surgical failure rate of .28%. It is suggested that these patients had microscopic tuboperitoneal fistulas in the cut ends of the tubes, and that fertilization occurred on the ovarian surfaces rather than in the oviduct ampullae. 5 of the pregnancies were ectopic, and all were found in the distal ends of the tube. The authors have modified the surgical technique by eliminiating division and using only wide electrocoagulation, with the triple-burn technique of Wheeless, and the Kleppinger bipolar forceps, in hopes of improving the success rate. The modifications also eliminate the risk of burns from unipolar current and of hemorrahage from biopsy.