The snare method of laparoscopic sterilization: an analysis of 1,000 cases with 4 failures

Abstract

The snare method has proven to be an effective method of tubal resection for sterilization. In the most experienced hands, significant complications are indeed rare. However, the failure rate appears to be higher than that of the coagulation-alone method, at least in the postabortal patient. The necessity for pathologic confirmation, a tradition of surgery, is critically questioned. Additional coagulation of the tubal ends after resection is now recommended, especially in the patient seeking abortion as well as sterilization. The authors await the comparative long-term results of bipolar forceps and the newer mechanical methods of laparoscopic tubal sterilization. It is conceivable that the snare and other unipolar electrosurgical instruments designed for female sterilization will become obsolete.

PIP: This paper reports the experience with 1000 patients who were sterilized with the snare method and followed up for at least 2 years. In most cases, the surgery was performed on an outpatient basis with general anesthesia and endotracheal intubation. The snare method was originally developed to produce a recognizable specimen to confirm that tubal integrity had been interrupted. The high complication rate (13/93 cases) when the method was 1st introduced was reduced dramatically by strict adherence to proper operator education and close supervision of equipment care. 4 pregnancies have been reported in 2 years of follow up. These pregnancies, all of which were intrauterine, occurred 11, 22, 28, and 32 months after sterilization. 2 of these patients had mesothelial fistulous tracts between the resection sites; the other 2 had complete, spontaneous reanastomoses. All 4 patients had had a concomitant pregnancy termination at the time of sterilization. The failure rate obtained in this study (1/250) is higher than that of the coagulation alone method, at least in postabortal patients. Because of the small surface area of the snare wire, the method cannot produce the degree of tubal tissue destruction required for successful sterilization. An additional coagulation of the proximal stump after snare resection would probably diminish or reduce the failure rate; however, newer mechanical methods of laparoscopic tubal sterilization may prove to be more efficacious than the snare and other unipolar electrosurgical instruments.