TUBAL STERILIZATION

REASON FOR VISIT

•Permanent contraception
•Pregnancy risk

RISK ASSESSMENT
•Diaphragmatic hernia

•Heart diseases
•Pulmonary disorders
•Hypertension
•Diabetes

•Pneumoperitoneum
•Pregnancy
•Suspected pregnancy

•PID
•Bleeding disorders

•Allergy to medication
•Allergy to anesthesia
•Prior abdominal surgery

PREPARATION OF THE PATIENT

•Blood tests
•Urine tests
•Urine human chorionic gonadotropin
•Pap smear
•X-ray chest
•X-ray abdomen
 •ECG
•Gonorrhea and chlamydia screening
•USG

•CT-scan

•Blood thinning medication was stopped

•Part was prepared and draped

ANESTHESIA
•Local anesthesia
•General anesthesia

•Spinal anesthesia

POSITION OF THE PATIENT

Supine position

THE PROCEDURE

MINILAPAROTOMY
•______ cm periumbilical semilunar incision was made with the skin

tented with Allis clamps.

•Dissection was carried down to the fascia, grasped with hemostats

/Allis clamps and opened transversely, exposing the peritoneum,

and entered sharply.
•The tubes were visualized and grasped with a Babcock clamp.

•The fallopian tube was "walked" with Babcock clamps and the

fimbriated end was identified.

•The fallopian tubes were tied up with catgut sutures
•Each limb of the tubal knuckle was cut separately.

•The endosalpinx at the cut ends was cauterized

 •The ligation sutures were held

•the tube was cut to prevent retraction of the tubal stumps into the

peritoneal cavity
•Both sides tubal ligation was done

•The minilaparotomy incision is closed in layers.

•The fascia was closed with running 2-0 or 0 delayed absorbable

suture
•The skin was closed with 3-0 or 4-0 absorbable suture in a

subcuticular manner/ with acrylic glue.

LAPAROSCOPY

Electrodesiccation technique
•Small periumbilical incisions were given

•Laparoscope was inserted from the incision

•The oviduct was identified and grasped at the mid isthmus region,

2.5-3 cm laterally to the uterotubal junction, with the bipolar

forceps.
•The tube was elevated to ensure the forceps are not in contact with

any other structure

•Current was applied and the procedure was repeated 2-3 times for

each tube to create a 3-cm contiguous area of desiccation

Mechanical technique
•The isthmic portion of the fallopian tube was identified.

•The forceps of the applicator were extended and a segment at

least 3 cm from the uterine cornu was grasped

•____cm of tube was gently pulled into the barrel using a slow

"milking" technique.
 •The larger-diameter outer barrel was pushed the Falope ring over

the knuckle of tube, and the ring returns to its former state, with an
inner diameter of 1 mm.
•Slowly advanced the entire applicator towards the tube while

gradually retracting the tongs and tube into the applicator

HYSTEROSCOPY
•A 5-mm operative hysteroscope with a 5-French operating channel

was inserted under direct vision through the cervical os, and the
uterine cavity was entered.
•Normal saline was used for the distension medium

•Both tubal ostia were identified.

•The device was passed through the operating channel and guided

into the tubal ostium to the depth of the black indicator on the outer
cannula.
•With the applicator steadied against the hysteroscope, the wheel on

the handle was rotated

•The device was deployed by pressing a release button and turning

the wheel again.

•The coils were allowed to spontaneously expand for approximately

10 seconds.
•The handle was rotated in counterclockwise, separating the delivery

wire from the coils.

•The device was retracted from the operating channel and the

procedure was repeated on the contralateral side.

•Hysteroscope was removed from cervix

AFTER CARE
•Patient was observed for bleeding/ pain/temp
 •Blood pressure, heart rate was monitored

DURATION
______min

POSTOPERATIVE CARE
•Take pain medication as prescribed
•Take antibiotics as prescribed

COMPLICATIONS
•Bowel injury
•Vascular injury
•BTL failure
•Pain
•Infection
•Hemorrhage
•Bladder injury

•Uterus injury