A total of 250,136 laparoscopic sterilizations by a single operator

Abstract

A total of 250,136 women were sterilized as outpatients by a single operator working with a team in ad hoc sterilization 'camps'. Falope rings were applied by the laparocator under local anaesthesia, with premedication but without vaginal manipulation (in all but the first 10,100). Volunteers were recruited and the operation discussed in nearby villages. The women were numbered at registration and arranged in groups, each comprised of two rows (odd or even numbers) of 15 women, leading to two improvised operating tables or benches in a steep Trendelenburg position. With good teamwork the number of women sterilized was generally 40 to 50/h. There were 12 associated deaths, not all attributable to the procedure, a mortality rate of 4.8 per 100,000; 8 major complications (3.2 per 100,000) required laparotomy or admission to hospital. In a follow-up survey of 84,940 responders to a questionnaire only 90 pregnancies (0.1%) were reported to have been conceived after the cycle of surgery. The results suggest that the rapid 'no exposure' technique as used in this series is safe and acceptable in an Indian context. If others could acquire this skill it could with appropriate adaptation make appreciable inroads into the unmet need for female sterilization in many other developing countries.