Laparoscopic sterilization in a free-standing clinic: a report of 1,092 cases

Contraception. 1984 Dec;30(6):545-53. doi: 10.1016/0010-7824(84)90004-0.

Abstract

The five-year experience of 1,092 laparoscopic tubal sterilizations performed in a free-standing clinic in the U.S. with no anesthesiologist under local anesthesia is reviewed. The current technique of the Hasson "open" method and bipolar cauterization is felt to minimize major mishaps and is acceptably comfortable to the patient.

PIP: The experience of performing a conseceutive series of 1092 tubal sterilizations, using a local anesthesia, at a free standing outpatient clinic in the US between 1976-81 is reported. The clinic's experience demonstrated that low cost sterilizations could be performed safely in a facility lacking a general anesthesiologist, a blood bank, and a laporatomy set-up. Initially, unipolar forceps and closed laporscope tocar insertion was used, but in 1977 clinic personnel began using Kleppinger bipolar forceps to reduce the risk of ectopic burns and Hasson's open laparoscopy method to reduce the risk of extraperitoneal gas insufflation and vascular injury. Patient were initially screened over the telephone for cardiopulmonary disorders and other contraindications. 72 hours before the operation, they were counseled and informed of the risks. Preliminary laboratory examinations included blood counts, urinalyses, Papanicolaou smears, and gonorrhea cultures. In performing the sterilizations the local anesthestic, Xylocaine, was used. Surgical procedures included 1) administering a tranquilizing agent and an analgesic intravenously, 2) performing a paracervical block using a local anesthestic; 3) achieving uterine elevation; 4) infiltrating the subumbilical layers of the anterior abdominal wall with local anesthestic; 5) making a 1.5 cm incision; 6) inserting a 10 mm operating laparoscope; 6) creating pneumoperitoneum with nitrous oxide; 7) spraying and infiltrating the isthmic portion of the fallopian tubes with the local anesthestic; 8) cauterizing the tubes at 3 sites; and 9) releasing the pneumoperitoneum and closing up. Operating time is 15 minutes. The patient is observed for an hour and then discharged. The 1092 patient treated at the clinic had a median age of 31.7, a mean gravidity of 2.9, and a mean parity of 2.0. 17% had never delivered, 12.1% had never married, and 36% used no previous method of contraception. At the time of sterilization, 87 of the patients had IUDs removed, and 100 had abortions performed. Between 1976-81, complications associated with the sterilizations included 1) 2 cases of pelvic infection; 2) 7 cases of abdominal pain; 3) 6 cases each of incision bleeding, incision hematoma, and dysmenorrhea; and 4) 1 case each of vaginocervical laceration, vaginal bleeding, and paralytic ileus. 4 pregnancies were reported following sterilization, and 2 of these were ectopic pregnancies. 3 of the pregnancies occurred during the 1st 2 years of clinic operation, and only 1 during the last 3 years.

MeSH terms

  • Adolescent
  • Adult
  • Female
  • Follow-Up Studies
  • Humans
  • Laparoscopy*
  • Middle Aged
  • Postoperative Complications / etiology
  • Pregnancy
  • Risk
  • Sterilization, Tubal / methods*