Laparoscopic tubal sterilization coincident with therapeutic abortion by suction curettage.

Abstract

This is a report of the first 100 patients undergoing laparoscopic tubal sterilization concurrent with therapeutic abortion by suction curettage. Operations were performed between May 15, 1971, and August 3, 1972, at the Women's Hospital, Los Angeles County Medical Center. Average age was 30.28 years. 58% were Spanish-speaking, 28% were Caucasian, and 14% Negro. 33% were single; 18% divorced. Mean gravidity was 6; parity was 4. Average period of gestation was 10-11 weeks. 17 had a history of prior abdominal-pelvic surgery. Patients were admitted to the hospital 1 day before operation for history and laboratory tests and the operations were performed by resident doctors supervised by senior obstetric-gynecologic residents. After general anesthesia was administered, Berkeley suction apparatus was used for therapeutic abortion. After suction curettage a cannula or Hega dilator was left in the uterine canal to manipulate the uterus for the laparoscopy. A pneumoperitoneum of 3-4 liters of carbon dioxide was created. The laparoscope was positioned through a small transverse incision and the oviducts coagulated until a distance of 2 cm was well blanched on either side of the grasping forceps. Then the tubes were severed. Subsequently a mild elevation of temperature occurred in most patients. Usually patients were discharged the next morning. Some required postoperative medication for pain. Subsequent pregnancies have not occurred. Bleeding required emergency laparotomy in 1 patient, bowel perforation with the Verres needle during carbon dioxide insufflation occurred without further complication in 1 patient, and endometritis was diagnosed in 2 patients 4 days after operation. Failure to establish pneumoperitoneum occurred 2 times, requiring laparotomy to accomplish sterilization. A patient with a history of pelvic inflammatory disease had adhesions which prevented visualization of both adnexa so a laparotomy was done. An unrecognized burn in an obese patient is presumed to have caused clear yellow fluid to exude from the puncture site, but this resolved spontaneously. The method is considered safe and as free of complications as laparoscopy in the nonpregnant patient.