Female sterilization by endoscopic methods.

Physicians can use either the single puncture or the 2 puncture technique to perform laparoscopic tubal sterilization. They can perform laparoscopy on an inpatient or outpatient basis using local or general anesthesia. Laparoscopic sterilization is the most popular method used in camp set ups in India. In these camps 200-400 women undergo sterilization. Necessary equipment for laparoscopy include a light source a fiber optic cable at least 1 trocar and cannula and an endoscope. Contraindications to laparoscopy are severe respiratory dysfunction decompensated heart disease large abdominal wall or diaphragmatic hernia and large abdominal tumor. If physicians plan use electrical methods to occlude the tubes they should use carbon dioxide for pneumoperitoneum. They should be aware of the risk of gas embolism with insufflating gases however. Unipolar and bipolar cautery and endothermic coagulation comprise the electrical methods which pose some small risks. Nonelectrical methods tend to be safer and include spring loaded and silicone titanium clips and the Falope ring. Clips have the best chance of sterilization reversal. In India laparoscopic sterilization cases most often have Falope rings. They cause postoperative pain in 5-50% of cases however which is higher than electrocautery thermocoagulation and the clip. Even though there are fewer complications with laparoscopic sterilizations than with laparotomy and minilaparotomy the few complications which do occur are serious and sometimes life threatening. Reversibility of laparoscopic sterilizations range from 45-100% (mean 75%). Few health workers perform sterilizations using the vaginal approach because the culdoscope limits their wide view of the pelvis and the upper abdomen. Yet some health workers in Mexico prefer culdoscopic sterilization because it is effective simple and not costly. Hysteroscopic sterilizations has a high failure rate and tends to cause high rates of uterine perforation cornual pregnancy sepsis intestinal perforation and mortality. Thus most physicians have abandoned this approach.