Abstract

PIP: In 1971, 100 outpatient laparoscope bilateral partial salpingectomies were performed at Johns Hopkins Hospital under local anesthesia with systemic sedation. Ten percent of these patients (age, 21-45; parity, 1-8; weight, 110-200 lbs) had a history of pelvic surgery. The 2-incision technique, performed on 15 patients, used the viewing laparoscope and the Eder-Palmer biopsy tong through separate incisions. The large trocar incision was made in the inferior rim of the umbilicus rather than the lower midline, and the second incision was made in the midline rather than right or left lower quadrants to decrease the possibility of hemmorhage. The one-incision technique, performed on 85 patients, with the fiberoptic operating laparoscope with its associated electrocoagulation forceps, used a 1 cm incision in the inferior rim of the umbilicus alone. In all cases pneumoperitoneum was with CO2. The fallopian tube was thoroughly visualized by manipulating the uterus with Jacob's tennaculum and Rubin's cannula before the tube was grasped and cauterized. The incision was closed with a 4/0 chromic mattress suture placed subcuticularly and dressed with a bandaid. Discharge was after 2-3 hours routine observation in the recovery room with no restrictions placed on resumption of activities. The one-incision technique produced far less discomfort during the procedure and far greater acceptance than the 2-incision technique, which produced discomfort at two points and required the insertion of the second trocar with its associated additional manipulation of the peritoneum and fallopian tubes. Of the 85 patients having the one-incision technique, only three patients had some difficulty and required some systemic sedation.