Laparoscopic tubal sterilization: Postoperative follow-up and late gynecological complaints

In 322 women who underwent laparoscopic tubal sterilization, the incidence of late gynecological complaints is examined, after adjusting the results for combination-pill use before sterilization and for pre-existing gynecological complaints.     

Laparoscopic tubal sterilization

Four different techniques of laparoscopic tubal sterilization are evaluated. Two, cryosurgery alone and electrocoagulation alone, were abandoned due to subsequent pregnancies. Electrocoagulation and cutting, using the Palmer biopsy drill forceps, or a modification using 2 instruments for coagulating and for cutting are still used under general anesthesia. Discharge was 24 hours later. Hysterosalpingography was done in 50 cases, 10-12 weeks postoperatively. In one patient there was spill from the medial stumps. There was 1 subsequent pregnancy, but hysterosalpingograms had shown occlusion. The major operative complication was bleeding of which five cases required laparotomy. Other complications included perforation of stomach and large bowel serosa; cardiac arrhythmias during the procedure, perforation of the uterus by the dilator, and failed pneumoperitoneum. Electrocoagulation followed by tubal cutting is the preferred method.     

Laparoscopic tubal reanastomosis

Traditionally, tubal reanastomosis has been performed microscopically via laparotomy. The laparoscopic approach has revealed high pregnancy rates comparable with those obtained after microsurgery by laparotomy and yields important advantages such a less postoperative discomfort and fewer complications, no incisional scar, a shorter recovery time, and earlier resumption of normal activities. The one-stitch technique gives a good approximation of the tissues with a shorter operative time and successful results. In this report we present a case of tubal reanastomosis by laparoscopy using the one-stitch technique, which resulted in an intrauterine pregnancy.     

Laparoscopic microsurgical tubal anastomosis

The authors explored the feasibility of performing true microsurgery through the laparoscope in 1990. The first laparoscopic microsurgical tubal anastomosis was performed in February 1992. Operative laparoscopy will continue to expand as technical feasibility continues to improve, driven by both hardware advances and increased surgical dexterity. Laparoscopic microsurgery will introduce a new dimension to reproductive surgery and over time, will replace laparotomy for microsurgery.     

Laparoscopic tubal anastomosis.

OBJECTIVES: To evaluate the pregnancy outcome after laparoscopic tubal anastomosis. METHODS: From December 1998 to December 2001, 26 patients with bilateral tubal ligation who underwent laparoscopic tubal anastomosis were prospectively evaluated. Patients' age varied from 28 to 37 years. RESULTS: Laparoscopic tubal reversal was performed in 23 patients. Bilateral reversal was possible in all but two patients. The operation time ranged from 95 to 155 min and all patients were discharged in the following morning after surgery. After 3 months, tubal patency was confirmed in 15 patients (15/23). Pregnancy rate was 56.5% (13/23), without ectopic pregnancies. The average time from tubal reversal and pregnancy was 6 months. CONCLUSIONS: In selected cases, laparoscopic tubal reversal can be offered to patients who had been submitted to tubal sterilization and desire new pregnancies. Patient selection as well as meticulous surgical technique are key factors in achieving satisfactory pregnancy rates.     

Laparoscopic tubal ligation. A follow-up report on the Yoon falope ring methodology.

The Yoon Falope Ring methodology was examined on a prospective basis in 2299 patients from October 1973 through June 1978. The Yoon Falope Ring, made of medical-grade silicone rubber, can be applied by single- or double-puncture laparoscopy, by minilaparotomy, or transvaginally by either colpotomy or the culdoscopic technique. The patients were followed at 6-month intervals when possible. An overall follow-up rate of 75%, for a total of 37,140 woman-months, was achieved. The most significant complication was tubal transection; this occurred in 76 (3.3%) of cases during the study period. To date, the overall pregnancy failure rate, excluding luteal phase pregnancy, is 0.42% per 100 woman-years. As a laparoscopic methodology its versatility is well suited for outpatient, local anesthetic use. Although serosal bowel application was encountered in 2 early cases, it does not pose the same potential morbidity as does the bowel burn associated with electrocoagulation. A ring application to the serosal surface of the bowel can be removed laparoscopically, whereas a burn to the bowel requires laparotomy for probable resection and reanastomosis of the involved area. Intraand post-operative pain may be slightly higher than with electrocoagulation but is less than with the Pomeroy procedure. The advantages of the technique are multiple. It is a simple, safe, effective and easily learned methodology. It eliminates the morbidity and mortality associated with coagulation sterilization. When used in a training program, it is easily adaptable to a variety of surgical approaches.     

Laparoscopic salpingectomy for tubal pregnancy

This study presents 100 consecutive cases of total salpingectomy by laparoscopy for the treatment of ampullar ectopic pregnancy. A three-puncture technique was used, and the salpingectomy was done by thermocoagulation and transection of the isthmus, mesosalpinx, and tubo-ovarian ligament. Tubal extraction was accomplished by one of the suprapubic punctures with the use of a polyp forceps. No complications have been encountered during the operation. However, because of severe pelvic adhesions or a voluminous hematocele, laparotomy was used in two cases (2%). The only postoperative complication was a deep vein thrombosis in one of the patients. A second-look operation was performed in 36 cases, and good healing with no adhesion formation at or near the site of salpingectomy was found. This technique therefore appears to be simple, fast, and almost complication-free.     

Laparoscopic treatment of tubal pregnancy

Seventeen tubal pregnancies were treated successfully with a laparoscopic procedure over the past four years. Four different laparoscopic techniques were used: salpingectomy, partial salpingectomy (midtube resection), fimbrial expression, and salpingotomy. "Preventive hemostasis" using vasopressin has made salpingotomy our treatment method of choice. Ruptured tubal pregnancy was not considered a contraindication to laparoscopic treatment. Four of the six women who were trying to conceive and were followed for longer than six months have had documented intrauterine pregnancies; one woman subsequently developed a contralateral tubal pregnancy which was treated by laparoscopic salpingotomy. Tubal ectopic pregnancy, even in the presence of rupture, can be managed effectively by a variety of laparoscopic techniques with benefits including minimal incision, short hospitalization, early return to full activity, and in many cases, a patent tube.     

Laparoscopic sterilization using tubal rings and clips

From 1978 to April 1980, 36 laparoscopic sterilization procedures were completed at the Gynecological Department in Maribor. For tubal occlusion in 16 cases Tupla clips and in 20 cases the Tubal Falope ring were used. It appears that the incidence of complications and other technical difficulties is somewhat more frequent with clips. There have been no pregnancies in all these cases.     

Laparoscopic tubal surgery in infertility.

Besides its diagnostic value, laparoscopy is a useful operative tool in the treatment of infertility. We have used dilatation of phimotic tubal ostia and salpingolysis by laparoscopy as our primary approach. In the total series of 33 cases a pregnancy rate of 42.1 percent was obtained.     

Laparoscopic management of tubal pregnancy.

Early detection of an unruptured tubal pregnancy has been made possible by the recent use of vaginal sonograms, thus more conservative management can be undertaken. From February 1989 to June 1989, we attempted to treat tubal pregnancies by surgical laparoscopy at the Keelung Chang Gung Memorial Hospital. Fourteen consecutive cases of tubal pregnancy were treated by surgical laparoscopy with a success rate of 70% (10 out of 14). Six of the 10 successfully treated cases were managed conservatively. Use of the laparoscope may be considered as a major trend towards conservative tubal pregnancy treatment, such as salpingotomy for women with an unruptured ectopic pregnancy who want to conserve fertility. These 10 cases of tubal pregnancy benefited enormously from the surgical laparoscopic technique which led to a shorter hospital stay, early ambulation and resume point of normal activities within days. No complications related to surgical laparoscopy were noted in this series. Our conclusion is that surgical laparoscopy should be considered an alternative to laparotomy for the treatment of tubal pregnancy.     

Laparoscopic tubal sterilization: monopolar and bipolar electrocoagulation

The study describes 73 interventions of female sterilization obtained laparoscopically by monopolar or bipolar electrocoagulation. Indications for sterilization were essentially medical; 86.2% of patients were above 30, and average parity was over 3. Operative procedures went very smoothly; there were 5 cases of complications: 2 emphysemas caused by pneumoperitoneum, and 3 cases of hemorrage of the mesosalpinx. Hospital stay never exceeded 4 days. No pregnancies were reported, and menstrual cycles and sexual life were quite normal after the procedure. The article also reviews the monopolar electrocoagulation.     

Laparoscopic tubal clip sterilization under local anesthesia

Tubal anesthesia with lidocaine during laparoscopic tubal clip appli cation was evaluated in 149 women; 147 tubes received no lidocaine and 151 received 1 or 2 ml of 1% or 4% lidocaine. For unanesthetized tubes the mean pain rating depended on the dose of diazepam and fentanyl given to the patient (p less than .1); pain ratings were higher in women who received no drug. When any diazepam and/or fentanyl was given, the anesthetized tubes were given a significantly lower pain rating (p less than .01). 23.8% of unanesthetized tubes received a pain rating of 2, 12.9% a rating of 3 or 4, while no anesthetized tube received a 3 or 4 (on a scale of 0 to 4) and only 4% received a 2. 68.5% patients were their own control; 42% rated the pain equal in each tube (1 was anesthetized), while 58% rated the anesthetized tube less painful. 3.4% of the patients experienced vasovagal reflex stimulation. It is concluded that using a local anesthetic solution substantially reduces discomfort associated with fallopian tube manipulation during sterilization.     

Laparoscopic surgery for tubal pregnancies utilizing laser

Nine cases of ectopic pregnancy were treated by laser supported tubotomy and subsequent endoscopic evacuation by a forceps. The location of the ectopic pregnancies were as follows: ampulla (one patient); isthmus (five patients); and fallopian tube (three patients, in two of whom the whole tube was a hematosalpinx). The incision in the tube was made on the antimesenteric side according to the position and size of the ectopic pregnancy using an Nd YAG laser. Tissue destruction of the Nd YAG laser was diminished by using a crystal. After the incision, the conceptional debris was removed by a forceps. In all cases the fallopian tube was left open. Three months after the operation an X-ray was performed. In all nine cases, patent tubes could be documented on the affected and on the contralateral side. In the two patients with hematosalpinx, adhesions of the treated tube were found.     

Laparoscopic tubal sterilization using thermal coagulation.

A technique using a low-voltage, rechargeable battery pack and a cautery hook assembly for thermal coagulation and division of the fallopian tube under laparoscopic visualization has been evaluated in 393 patients. The procedure is quick, easy to perform, and electrically safe. The gross extent of the burn to the fallopian tube by thermal coagulation and division was compared with that done by high-frequency unipolar electrocoagulation and division. The difference in the mean total gross tubal burn produced by the 2 methods is not statistically significant. The variance of total tubal burn in individual cases within each group is significantly greater in the electrocoagulation group. The authors assume that pregnancy rates in patients undergoing thermal coagulation and division will be no different than those reported in patients in the electrocoagulation and division group. Two hundred of the patients have been followed from 12 to 33 months and no method-failure pregnancies have occurred.     

Laparoscopic tubal ring sterilization under local anesthesia

In a series of 200 consecutive patients the Falope-Ring technique for tubal sterilization was performed under local anesthesia using a single puncture technique. It is concluded that local anesthesia adds to the safety of the procedure and that the method is acceptable for routine procedure.