Document Detail

Laparoscopic tubal sterilization. Methods, effectiveness, and sequelae.
MedLine Citation:
PMID:  10083931     Owner:  NLM     Status:  MEDLINE    
The following statements summarize the material presented herein. 1. Although laparoscopic tubal ligation remains an effective and widely available form of birth control throughout the world, cumulative failure rates may be higher than previously reported, and patients should be appropriately counseled, with special attention to younger women. 2. Proper surgical technique is important in reducing failure rates, particularly with regard to applying clips or using bipolar cautery. Teaching institutions should employ strict guidelines for instructing residents in the most effective techniques. 3. Although overall rates of ectopic pregnancy are lower after tubal ligation (as is true with any form of birth control), should pregnancy ensure from a failed procedure, there is a 30% to 80% chance of ectopic pregnancy. Consideration should be given to earlier ultrasound and documentation of the location of the pregnancy. 4. There is little evidence to support PTLS from a biologic standpoint. The data on increased hysterectomies in post-tubal patients may be a result of multiple factors, particularly for women aged less than 30 years at the time of occlusion. 5. Although the majority of women report satisfaction with sterilization, thorough counseling for all women cannot be overemphasized. Women aged less than 30 years should be completely aware of all alternatives and possibly encouraged to try another method prior to permanent sterilization.
This article details laparoscopic techniques of tubal sterilization, with a review of current literature addressing their effectiveness and common sequelae. Throughout the world, tubal ligation accounts for about 10-40% of the contraceptive methods. A brief explanation is stated on the timing of sterilization. Some of the methods for laparoscopic sterilization include the following: 1) unipolar coagulation; 2) bipolar coagulation; 3) silastic band application; 4) spring clip application; 5) filshie clip; and 6) laparoscopic Pomeroy procedure. Recent advances were also given, such as microlaparoscopy for fiber-optic technology, and performance of office laparoscopy under local anesthesia. However, despite the fact that laparoscopic tubal ligation remains to be an effective form of birth control throughout the world, cumulative failure rates remain high and patients should be appropriately counseled. Furthermore, women aged less than 30 years should be aware of all alternatives prior to permanent sterilization.
R M Ryder; M C Vaughan
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Obstetrics and gynecology clinics of North America     Volume:  26     ISSN:  0889-8545     ISO Abbreviation:  Obstet. Gynecol. Clin. North Am.     Publication Date:  1999 Mar 
Date Detail:
Created Date:  1999-04-05     Completed Date:  1999-04-05     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  8709551     Medline TA:  Obstet Gynecol Clin North Am     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  83-97     Citation Subset:  IM; J    
Division of Gynecology, Eastern Virginia Medical School, Norfolk, USA.
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MeSH Terms
Attitude to Health
Electrocoagulation / instrumentation
Gynecology / education
Internship and Residency
Laparoscopy / adverse effects,  methods*
Patient Satisfaction
Pregnancy, Ectopic / etiology,  prevention & control,  ultrasonography
Sterilization, Tubal / adverse effects,  instrumentation,  methods*
Treatment Failure

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