Two hundred out-patient laparoscopic clip sterilizations using local anaesthesia

Abstract

Female sterilization using clips applied laparoscopically under local anaesthesia was used in 200 women. Apart from two patients in whom there were technical difficulties, the operation was completed without complication and without immediate or delayed morbidity. The technique, which avoids the risks of general anaesthesia, is commended as a safe, simple method of sterilization suitable for, and acceptable to, the majority of women.

PIP: The first 200 consecutive laparoscopic sterilizations at the Churchill Hospital, Oxford, using local anesthesia and Filshie clips, are presented in detail. 4 or 5 operations were scheduled per half day, with a gynecologist-surgeon, an anesthetist, and 4 nurses. Most patients received only local anesthesia, with care to reach the peritoneal layer; those with anxiety also received midazolam. Lignocaine was dropped on the clip sites. The laparoscope was a 7 mm Storz. After the procedure, gas was expelled with the Valsalva maneuver, and No. 1 silk sutures were applied where necessary. Vaginal manipulation was needed in 38 women for retroverted uterus. Other difficulties included adhesions precluding completion of the operation in 1 and obesity in another, and in 10 others minor adhesions, or omentum or bowel overlying the field. Postoperative complaints included pain in 148 treated with iv or oral analgesics, vomiting in 10, hypotension in 8. 194 of the women returned questionnaires about the experience, and 91% of these said they would recommend laparoscopic sterilization under local anesthesia to a friend. It was felt that elimination of preoperative pain medication, used in the first few patients, as well as early mobilization, sped up recovery. The specific pain complaints were fewer than those in several reports, possibly because of the gentler handling entailed in a procedure done by local, rather than general, anesthesia.