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Laparoscopic sterilization in the supine position using the Ramathibodi uterine manipulator
1Johns Hopkins Bayview Medical Center, Department of Obstetrics and Gynecology, Baltimore, Maryland 21224, USA.
Objectives:
To investigate the usefulness of the Ramathibodi uterine manipulator (AMZURA Enterprises, Freeport, NY) in performing laparoscopic sterilization procedures in the supine position under local anesthesia.
Design:
Descriptive prospective study.
Setting:
Ambulatory surgical unit of university-affiliated hospital.
Patients:
Women presenting for elective sterilization and weighing < 110 kg.
Intervention:
The Ramathibodi uterine manipulator was used to provide uterine manipulation in 85 cases of laparoscopic sterilization, all performed in the supine position as local anesthesia-sedation sterilization operations. Because such procedures are becoming more common worldwide, we propose the acronym "LASSO" (Local Anesthesia-Sedation Sterilization Operation) for this class of operations. Although commonly used in minilaparotomy procedures, use of this uterine manipulation device in laparoscopic procedures has not been published previously.
Main Outcome Measure:
Successful tubal occlusion.
Results:
Among the 85 cases reported here there were no failures to manipulate the uterus successfully, to identify the tubes, and to occlude them.
Conclusions:
The simplicity of the Ramathibodi uterine manipulator provided several advantages over other means of uterine manipulation, notably [1] constant easy-to-learn maneuvers, [2] no tenaculum or balloon requirement, [3] the procedure could be performed in the supine position, and [4] there are no working parts, screws, or springs that could be lost or broken by operating room staff. Our experience with this device leads us to recommend it to colleagues as an inexpensive, safe, and effective alternative to currently available instruments for providing uterine elevation during laparoscopic sterilization procedures.