[Other indications: tubal sterilization, medically assisted procreation, salpingitis, fibromas]

Abstract

Tubal sterilization is now commonly performed by laparoscopy. Among the available techniques, clips are easy to install and have a low failure rate. Laparoscopy is of considerable value in salpingitis for the diagnosis and treatment of tubo-ovarian abscesses. In medically assisted procreation, laparoscopy is less and less necessary. GIFT and, chiefly, ZIFT are still performed by laparoscopy in case of infertility with normal Fallopian tubes. Laparoscopic myomectomy is a more recent technique, but further experience is needed to assess its value compared with laparotomy.

PIP: Tubal sterilization is performed during laparoscopy in most cases under general anesthesia or under local anesthesia when clips are used. Electric techniques comprise bipolar coagulation or thermocoagulation. The Hulka clip and Filshie clip methods are most prevalent. The Yoon ring consisting of a silicone ring is also widely used. The failure rate of different tubal sterilization methods reaches about 5%, chiefly as a result of technical error. Complications are very rare, mainly bleeding of the middle portion which can be stopped by coagulation. Laparoscopy once was the only method of in vitro fertilization, i.e., by collecting ovocytes under general anesthesia. It is rapidly being replaced by echo-guided outpatient techniques of ovocyte collection under laparoscopy: GIFT and ZIFT. GIFT is intratubal transfer of gametes by follicular puncture. The aspirated follicular liquid is examined to harvest a maximum of 3 mature ovocytes that are mixed with about 50,000 previously prepared spermatozoa and reintroduced into the tubes. In ZIFT performed under echography ovocytes are inseminated with spermatozoa, and then a maximum of 3 zygotes are transferred into 1 tube. In unexplained or masculine sterility ZIFT is preferred, as the use of laparoscopy is also avoided. Laparoscopy is used for the diagnosis of salpingitis, especially in severe, acute cases. In operation it is used in the treatment of pyosalpinx, and satisfactory drainage of the abscess is often obtained with rapid regression of clinical symptoms. Myomectomy by laparoscopy is relatively recent, mostly reserved for myomas with a diameter of less than 5 cm once size has been measured by echography and a luteinizing hormone releasing hormone agonist has been taken for 2-3 months for reduction of its size. Hemostasis at the uterine implantation site of the myoma is achieved by thermocoagulation or monopolar coagulation.