Laparoscopic sterilizations (16,803) without vaginal manipulation
Mehta, P.V.
International Journal of Gynaecology and Obstetrics the Official Organ of the International Federation of Gynaecology and Obstetrics 20(4): 323-325
1982
ISSN/ISBN: 0020-7292 PMID: 6127267 DOI: 10.1016/0020-7292(82)90063-7Document Number: 388880
A single puncture technique for performing laparoscopic sterilization with a Falope Rings, which dispenses with a uterine manipulator, was developed. Experience with 16,803 cases over the September 1980 to June 1981 period is presented. This method was intended to be more acceptable to orthodox rural Indian women who resent vaginal manipulation exposing their genitalia. Local anesthesia and neuroleptanalgesia of diazepam and pentazocine and premedication with atropine were used. Prior to this, the patient walked to the inclined operating table dressed in her own clothes and lay down in a position shown in a figure (steep head low position for no exposure method). The patient's clothes require only slight rearrangement to facilitate the procedure. On introducing the single puncture laparoscope infraumbilically, the uterus and the medial part of the fallopian tubes were seen clearly most of the time. To bring the tubes into view when only part of the fundus was seen, the shaft of the scope was introduced into Douglas' pouch to lift the uterus while withdrawing the shaft. In cases where the uterus was acutely retroverted and hidden in Douglas' pouch covered by the intestines, the scope was introduced deeper into the pouch. The shaft of the scope was then withdrawn after tilting the tip of the scope toward the abdominal wall and rubbing it against the posterior wall of the uterus. This helped to straighten the uterus and bring the fallopian tubes into view. The scope was sometimes introduced by the side of the pelvic wall behind the round ligament in cases of even more acutely retroverted uteri, thus finding its way deep enough in Douglas' pouch to lift up the appendages. In other cases, the distended intestinal coils defeated all the above effort to bring the appendages into view. Lifting the thighs and buttocks of the patient about 30-35 centimeters above the inclined table enabled the uterus and tubes to be seen as the intestines receded from the field. This same procedure was also used with markedly obese women. In all cases, the supine position of the patient was never changed. Except for 7 cases in which the uterus and appendages were covered with dense adhesions and the tubes could not be visualized, the tubes could be traced up to the desired length and ligation was successful. This no exposure method does not present any complications other than those recorded in the literature for laparoscopic sterilzation.