Birth Control Options

Laparoscopic Tubal Ligation

Although laparoscopic sterilization, is no longer a first-line approach to female sterilization, there are reasons why it may still be preferable in a small number of patients. These include patients with cervical stenosis (a cervix that does not permit the passage of even small instruments into the uterus), a uterine cavity that is very distorted by either fibroids, scar tissue or congenital anomalies, a history of pelvic inflammatory disease, a nickel allergy or simply because a particular woman may prefer this method. Women who require a diagnostic laparoscopy for other reasons, such as endometriosis, or even the removal of a gall bladder (cholecystectomy) may opt for this method of sterilization since it adds little to the procedure.

Laparoscopic sterilization is performed in an outpatient setting and requires several days of recuperation.

What is laparoscopy?

LaparoscopyFigure 1: This is a view of the uterus through the laparoscope

Figure 2: Shows elevation of the left fallopian tube along with cauterization

Figure 3: Shows completed cauterization and cutting of the left fallopian tube

Laparoscopy is a technique that uses a lit telescope placed into the abdominal cavity through a small 1cm (10mm, 3/8 inch) incision. Laparoscopy generally requires two incisions: one for the laparoscope (telescope) and one for the instrument that accomplishes tubal ligation. Laparoscopy telescopes are generally attached to a video camera that allows the surgeon to visualize the entire procedure on a television screen. These incisions are approximately 5 mm (1/4 inch) each.

Using this visualization technique, a second instrument can be placed into the abdominal cavity through a quarter-inch incision just above the pubic hairline. Through this second incision a special device called a “tripolar” forceps is inserted which will cauterize and cut each of the fallopian tubes.

In our experience, the pregnancy rates following a tubal ligation by any method is less than 1/200 cases. Recent data from the Centers for Disease Control reveal that tubal ligations performed in the United States have a failure rate as high as 2% (1 out of 50). We are proud of our data and feel that our failure rates are far better than the national average

Laparoscopic sterilization procedures are performed in the Highland Hospital Outpatient Department. The procedure itself is a 10-15 minute operation performed under general or spinal anesthetic. You can expect to spend about 4 hours at the hospital. Most of this time is spent preparing you for surgery, accomplishing your admitting physical and lab work, and allowing you to recover following surgery and prior to discharge.

During your brief stay in the outpatient department, you will meet nursing personnel that will care for you before, during, and after your procedure. You will also have an opportunity to meet and speak with your anesthesiologist.

Frequently Asked Questions (FAQs) about Laparoscopic Sterilization

Is it safe?
No operative procedure is complication-free. However, the rate of complications in the hands of a skilled and experienced surgeon is minimal. Rarely, the procedure is associated with injury to the bowel (1 per 1000). Minor complications such as nausea and vomiting or shoulder pain are much more common.

How long does the procedure take?

Tubal sterilizations generally take from 10-15 minutes to perform. The actual time at the hospital outpatient department will be about 4 hours.

How painful is it?

The use of smaller instruments creates less gas in the abdomen, making this a much simpler and less painful procedure. For most women, the pain is easily controlled with Ibuprofen, Tylenol, or aspirin (minor analgesics). Women are, generally, pain-free by the 3rd day after surgery.

How long will I be out of work?

We advise woman to take 2 days off from work following the procedure. Many women return to limited activity the next day and normal activity in 3-4 days.

How long will it take to feel “back-to-normal”?

About three days.

How effective is it in preventing pregnancy?

The failure rate of tubal ligations in our hands is approximately 0.5% (1 out of 200 women). Failure rates, according to the most recently published CDC study (1996), reveal an average failure rate across the U.S. of 2%. Failure rates are probably diminished with the coagulation methods (burning and cutting the tubes).

How long before it is effective in preventing pregnancy?

Immediately.

Can it be reversed?

Some methods are potentially “reversible”. These include the use of clips and rings. However, this procedure should be viewed as one that is not intended to be reversed. The truth is that with the modern use of in vitro fertilization (IVF), pregnancies can be achieved even after tubal ligations with very good success rates. However, IVF is expensive and not covered by insurance.

Is female sterilization covered by my health insurance?

Most medical insurers do cover sterilization procedures.

If I want more information, how can I get it?

Just call the office at 585-473-8770, or toll free at 1-888-272-7990 and ask for our videotape or a consultation with Dr. Wortman.