Laparoscopic sterilization with electrocautery, silastic bands and spring-loaded clips: report of our experience with 790 patients

Abstract

A comparative study was carried out in 790 women undergoing one of the 3 most frequently used laparoscopic sterlization techniques: high-frequency unipolar electrocoagulation of the tubes, application of silastic rings or spring-loaded clips to the tubes. The technical problems and per- and postoperative (early) complications are assessed. The use of high-frequency unipolar current has been superseded by today's mechanical and non-electrical sterilization methods. The spring-loaded clip method appears to be a sterilization technique with a minimum of severe complications, and theoretically the greatest chances for possible refertilization.

PIP: In a 7-year comparative study, 790 women were sterilized using either high-frequency unipolar electrocoagulation with tubal transection (133 women) and double coagulation technique without cutting (350 women), silastic rings (142 women), or spring-loaded clips (165 women). Complications using the electrocoagulation technique include electrical shock, intra-abdominal burns, bleeding due to inadequate electrocoagulation, and coagulation necrosis of the skin. Bleeding occurred in the placement of silastic rings due to blood vessel damage with the sharp prongs of the ring applicator. Excessive traction with the clip applicator may cause bleeding during clip application. The clips and silastic rings also may drop in the Douglas' cul-de-sac but may be removed from the abdomen. 2 tubal pregnancies and 1 intrauterine pregnancy occurred using the electrocoagulation technique, 1 intrauterine pregnancy with the silastic ring technique, and 1 intrauterine pregnancy with the clip technique. Spring-loaded clips have few disadvantages but a hydrosalpinx or edomatously thickened tube are contraindications. In addition, the clip technique may be a method of possible refertilization.