Safe laparoscopic surgery: tubal ligation without prior pneumoperitoneum

Twelve years of experience with tubal ligation by the laparoscopic route at two highly specialized centers of female sterilization are discussed; special attention is given to the technique and results achieved. The number of intraoperative and postoperative complications was very low compared with data reported elsewhere. This article attempts to present the knowledge gained by using the laparoscopic technique, at a time when the use of laparoscopic surgery is extending around the world. The direct insertion of trocars without prior pneumoperitoneum has proved to be safe, and the risks of intraabdominal (visceral or vascular) injuries are minimized by observing simple rules, such as clamping of the relaxed abdominal anterior wall with towel clips, maintaining sharpened trocars, and using the extended index finger as a limit to introduce only the tip of the trocars. We consider a medical history of previous laparotomy secondary to peritonitis and open abdominal treatment absolute contraindications for this technique.