Laparoscopic tubal sterilization. The potential for thermal bowel injury

One of the most severe complications of laparoscopic tubal sterilization is bowel burns, although they often go undetected at the time of laparoscopy. Controversy remains over whether these injuries are caused directly by operator error or indirectly from a hot oviduct's or instrument's inadvertently touching and burning the intestine. A study was performed to determine the potential for direct or indirect bowel burns using bipolar electrocoagulation in rabbits. The results indicate that neither a hot tube nor hot (recently used) forceps could cause injuries to the serosal surface of the intestine. That was true both of immediate injury and after one to five days of recovery. It was observed that the hot uterine tube caused significant bowel adhesions by five days after the procedure. Direct electrocoagulation of the bowel using 40 W for three seconds caused a minor, noticeable blanch on the bowel that was not detectable with gross or histologic means after one day of recovery. A direct bowel injury did result when 80 W was used for three seconds; the bowel became perforated after one day. These findings indicate that it is unlikely that one can produce a bowel burn indirectly from a hot uterine tube or instrument and that only a direct insult to the bowel appears to cause an injury. However, adhesions could be a complication of the procedure and should be considered.