Abstract

PIP: An account is given of an observation of mass laparoscopic sterilizations done by Dr. P. Mehta, an Indian surgeon who claims to have performed 250,000 female sterilizations in less than 10 years. His record is 156 procedures in just under 2 hours. This observation and videotaping session took place in a rural setting, with the women lined up on benches on the verandah of Belpukur College. The 150 operations were completed in about 4 hours, with the help of a large team of assistants. An independent audit of Dr. Mehta's patient records has produced no failures or complications, nor have there been any claims by relatives for the Rs. 10,000 payment for a patient who has died after laparoscopic sterilization by Dr. Mehta. It was recommended that Dr. Mehta do the following to improve the safety of his mass sterilizations: 1) provide counseling in the form of an information leaflet for each candidate; 2) have a female nurse give each woman a preliminary pelvic exam (none are given now because local women will not accept male examiners); 3) give the premedications pre-mixed in a single, separately sterilized needle and syringe, sufficiently early for the anesthetic to take effect, as by an assistant 30 women ahead of the current patient; 4) aspirate the puncture needle to ensure that it is not in an abdominal vessel or cyst; 5) improve the procedure of cleaning and sterilizing the trocar and laparocator, using clean soapy water with chlorine, clean boiling water, and formaldehyde gas if any blood had contaminated the instruments; 6) carry each woman on a stretcher to the recovery area; 7) finally, have Dr. Mehta greet each woman by name. It would also be beneficial if Dr. Mehta could take time to train others in his technique.