of Tubal Patency
Division via Laparoscopy
Modified Irving Technique
Sterilization - Ucheda Technique
of the Fallopian Tube
of the Ovary
of the Ovary
Sterilization by the
Minilaparotomy is ideal for thin women with no pelvic disease or adhesions.
The procedure is difficult to perform in obese women or in women who
have had inflammatory disease of the Fallopian tubes.
In thin, small patients it has the advantage of being
performed with instruments less costly than those for laparoscopy.
When the patients are given a choice, however, they usually prefer
laparoscopy because recovery is faster and less painful and they can
resume their activities much sooner.
The purpose of the procedure is to obstruct the Fallopian tubes.
Physiologic Changes. The Fallopian tubes are obstructed.
Points of Caution. The bladder must
be empty, or cystotomy can result. If more than 4 cm are needed to
enter the abdomen - the width of 2 adult fingers - the patient is too
obese for this operation, and a laparotomy should be performed with
the patient under general anesthesia.
The patient is placed in the dorsal lithotomy
position, and a thorough examination of the pelvis is performed
to rule out the presence of adnexal disease. The vagina is surgically
prepped. A Rubin cannula and Jacobs tenaculum are inserted into
the cervix and through the cervical os, respectively. The abdomen
is opened with a 4-cm transverse incision above the mons pubis.
A small self-retaining retractor is inserted
through the abdominal wall into the peritoneal cavity. The surgeon
manipulates the previously placed Rubin cannula and Jacobs tenaculum
on the cervix so that the fundus and cornua become readily visible
through the small abdominal incision.
A Babcock clamp is used to reach through
the incision and grasp the Fallopian tube.
The Fallopian tube is pulled
up, and a piece of 0 synthetic absorbable suture is placed around
a knuckle of the tube, which is excised with scissors.
The Rubin cannula is manipulated
to the other side, and a similar procedure is performed on the
opposite Fallopian tube.
The abdominal wall incision is closed in
layers. The skin can be closed with either subcuticular or through-and-through