An inexpensive laparoscopy system for female sterilization

Abstract

Laparoscopy has become an established procedure for female sterilization. The cost of the equipment remains excessively high, thereby reducing its availability to all physicians and patients who desire and need it. We have described an inexpensive--but highly effective--female sterilization system utilizing equipment that should cost in the range of $400.00.

PIP: The results of an attempt to design equipment that would be effective and safe for laparoscopic sterilization and would reduce the cost to the practicing surgeon are reported. In using the designed apparatus, all patients were treated on an outpatient basis. Local anesthesia with added sedation was used in 94% of cases. The equipment consisted of the standard fiberoptic Welch-Allyn pediatric sigmoidoscope modified by replacing the obturator with a sharp pyrimidal trocar. The fiberoptic light source was contained within the handle of the scope and connected to a 9 volt 7 ampere electrical source. A tubal occlusion device, used through a 2nd incision, produced occlusion with a silicone rubber band applied with a special applicator. A Rubin's cannula was placed in the cervix. A Touhey needle was used through an upper incision to penetrate the peritoneum, and carbon dioxide gas was supplied through a modified anesthesia bag. After the needle was withdrawn and the incision enlarged, the trocar and sleeve were inserted. A 2nd incision and trocar insertion were then done in the lower midline and the special applicator inserted. By maneuvering the uterus into a favorable position with the Rubin's cannula, silicone bands were placed on each tube and the instruments withdrawn. Successful operations using this system were done on 30 patients. The 2-incision electrocoagulation technique or Hulka spring clip method could be used instead of the silicone rubber bands. No serious complications or pregnancies followed. The cost of the special instrume nts should not exceed $400. This will enable all qualified and trained surgeons to acquire their own equipment and to perform female sterilizat ions as part of their gynecologic practice.