Other Surgical Procedures
1. Laparotomy (concurrent with cesarean delivery)
Laparotomy is an incision made in the abdominal wall to allow a physician to look at the organs. Bilateral tube ligation may be performed after closure of the uterine incision during cesarean delivery.
2. Mini-laparotomy
Periumbilical minilaparotomy is the most common procedure immediately after childbirth.
Postpartum tubal ligation is technically simple because the uterine fundus is at the level of the umbilicus, making the fallopian tubes readily accessible through a small periumbilical abdominal incision.
Minilaparotomy following delivery in the early puerperium is convenient, simple, and cost effective. However, if maternal or infant complications exist, sterilization should be delayed.
3. Hysteroscopy
The principle of this procedure is to place an implant in the fallopian tubes with the help of a Hysteroscope, which is a small telescope-like instrument, which is inserted into the uterine cavity.
The device works by inducing scar tissue to form over the implant, blocking the fallopian tube and preventing fertilization of the egg by the sperm. The small metallic implant is called the Essure System and hence the procedure is known as the Essure procedure.
1. Under local anesthesia a 5-mm operative hysteroscope is inserted under direct vision through the cervical canal, and the uterine cavity is entered.
2. The uterine cavity is distended with normal saline.
3. A special catheter that is inserted through the vagina into the uterus and then into the fallopian tube.
4. The catheter is retracted after placing the metal implant.
This process takes approximately 3 months to form complete occlusion, which is then documented by a hysterosalpingogram, where a dye is injected into the fallopian tubes and X-Rays are taken to document the block.
The patient must be counseled to use alternate forms of contraception for 3 months until a hysterosalpingogram can be obtained to confirm bilateral Tubal occlusion. This procedure cannot be reversed.
Unlike other currently available Tubal sterilization procedures for women, placement of an implant device does not require an incision or general anesthesia.
4. Vaginal approaches are rarely used because they are associated with a higher incidence of infection and are no longer recommended.
