Sterilization is surgically induced infertility. In women, this can be accomplished by removing the uterus or ovaries separately or together, or more commonly, interrupting fallopian tubes. Currently, the most common surgical procedure performed involves the use of an instrument called the laparoscope to clip, band, or coagulate the fallopian tube. These operations collectively are referred to as laparoscopic tubal sterilization.
The laparoscope is a sophisticated surgical instrument that allows access to body cavities through minute surgical incisions. This device is essentially a slender telescope with a self-contained system of illumination. The quality of these instruments allow a view of surgical structures that is superior to that achieved with the unaided eye. The minimally invasive procedures performed with the laparoscope have the advantage of allowing surgeries to be performed with far less tissue trauma and scar. This results in better cosmetic results, far less post-operative pain, and much shorter recuperative time than conventional surgery. It is generally agreed that laparoscopic surgery requires a high level of specialized skill to be as safe as conventional surgery.
We pioneered the use of laparoscopic tubal sterilization under intravenous and local anesthesia in the office environment. We have performed many thousands of these procedures singly or in combination with first trimester abortion safely, efficiently, and cost effectively since 1975.
We feel that this form of birth control is ideal for women who have firmly decided that they do not wish further childbearing, and who cannot, or do not, wish to use the other effective and convenient means of contraception currently available.
Our patients have been women who do not tolerate oral contraception, have had “pill failures”, forgetful with “the pill”, and who are intolerant of or have failed on intrauterine devices. There are women who fear “the pill”, Depo-Provera, Mirena, and Paragard, which are all excellent choices of contraception for properly selected patients. And, there are women who have a large number of pregnancies and “don’t trust” anything else.
Frequently, it’s simply a matter of wanting to avoid “ever having to think about contraception again”. Usually a vasectomy has been considered an alternative for the male partner.
The tubal ligation procedure is generally performed as follows: A prospective patient is evaluated medically to be certain that there is nothing precluding the surgery. Conditions that preclude surgery are rare.
The patient then receives intravenous drugs to induce “twilight sleep”. Local anesthetic is then administered to the lower portion of the umbilicus (navel). A 1/4-inch incision is placed in the umbilicus through which carbon dioxide gas is passed into the abdomen to create a clear bubble in which to operate. The laparoscope is then inserted. Looking through the scope, a built in tweezer-like instrument, is used to grasp a portion of the fallopian tube. A surgical electrical current is then passed through the tweezer-like instrument (called bipolar grasping forceps) that obliterates a 1-inch segment of the tube. Typically, the procedure takes about 10-15 minutes. The usual recovery room time is 1 hour.
There are no absolute restrictions on activities, though we do recommend rest for the balance of the day. The average patient has no significant post-operative pain and generally is back to all activities in 1-2 days.
Complications in our hands have been rare. Our success rate has been in the range of 99.5%. This is superior to all forms of contraception short of hysterectomy. Although we strongly advise patients to consider the surgery as permanent, there is a reasonable success rate to surgically reconnecting the tubes. More recently, the trend has been toward in-vitro fertilization (test tube fertilization) to by-pass the blocked tubes.
At this time we do not perform tubal reversals.