A new approach to tubal sterilization by laparoscopy

Laparoscopic tubal sterilization has been rapidly gaining acceptance as a nonpuerperal method of permanent fertility control. A number of problems have nonetheless been associated with this technique. For example, tubal destruction often exceeds that necessary for tubal occlusions, increasing the danger of thermal injuries and possibly such dysfunctional disorders as abnormal uterine bleeding and dysmenorrhea. Furthermore, excessive destruction precludes any possibility of later tubal reconstruction. In an attempt to avoid these problems, a new low-voltage unit with a rechargeable battery was evaluated. With this unit, cautery is provided under laparoscopic view with a spring-activated hook which retracts the fallopian tube into a Teflon shield, where it is coagulated and transected. Histopathologic studies of the healthy fallopian tubes of four women in their reproductive years treated by this method while the abdomen was open prior to an elective hysterectomy demonstrated minimal destruction of the mesosalpinx, with complete tubal occlusion and a coagulated area 10 mm in length. One hundred and sixty-five patients have been sterilized successfully by this method. Indications are that it may provide safe tubal occlusion without unnecessary destruction of the fallopian tubes and surrounding vasculature.