Why the laparoscopic route for tubal sterilization?
Palmer, R.
Contraception Fertilite Sexualite 12(7-8): 931-933
1984
ISSN/ISBN: 0301-861X PMID: 12266338 Document Number: 229001
The criteria of effectiveness of surgical methods of contraception include efficacy, innocuity, incidences of complications, acceptability, practicability, and reversibility. Acceptability depends on pain, the scar, and the durations of hospitalization, convalescence, and sexual abstinence. Pain is greatest during laparotomies and least for laparoscopic procedures in general. The scar is almost invisible after minilaparotomies, colpotomies, and laparoscopic sterilizations. The duration of hospitalization varies from a few hours after a laparoscopic sterilization under local anesthesia to 8 days after a classic laparotomy. Convalescence lasts for 3-4 weeks after laparotomies, 3-4 days after laparoscopic sterlilizations, and 1/2 day after applications of MCA. Sexual abstinence is required for 3-4 weeks after colpotomies and 2-3 days after laparoscopic sterilization. Acceptability is likely to be influenced by the atitude of the operator. The practicability of various methods depends on the personnel and equipment available. Laparoscopy requires a competent laparoscopist who preferably is also a surgeon, as well as the proper instrumentation in good working order and an anesthetist. For a number of years most sterilizations were done by laparotomy using the Madlener, Pomeroy, Lebhardt, or Rouchy techniques. The para-umbilical minilaparotomy for postnatal and postpartum sterilizations and the subpubic minilaparotomy using a uterine elevator were early innovations; the minilaparotomy is safe, not very painful, and has a failure rate of about .5%. Posterior colpotomy is difficult if the tube does not descend well, and involves risk of tearing. It is often necessary to do a ligature with excision of the last 2 cm of tube. Pelvic abscesses are possible and 2% fail because of fistulization of the ampulla. The culdoscopic technique of Clymer and Gutierrez has a relatively high failure rate and reduced likelihood of reversibility. Monoactive electrocoagulation in laparoscopic sterilization has been supplanted by biactive coagulation, by thermocoagulation, and especially by Hulka clips and Yoon rings. The failure rate is less than 1% and prospects of reversibility are good.