Laparoscopic Bilateral Tubal Ligation 1

Laparoscopic Bilateral Tubal Ligation Operative Report

Preoperative Diagnosis: Multiparous female desiring permanent sterilization.

Postoperative Diagnosis: Same as above
Title of Operation: Laparoscopic bilateral tubal ligation with Falope rings
Surgeon:
Assistant:
Anesthesia: General endotracheal
Findings At Surgery: Normal uterus, tubes, and ovaries.
Description of Operative Procedure
After informed consent, the patient was taken to the operating room where general anesthesia was administered. The
patient was examined under anesthesia and found to have a normal uterus with normal adnexa. She was placed in the
dorsal lithotomy position and prepped and draped in sterile fashion. A bivalve speculum was placed in the vagina, and
the anterior lip of the cervix was grasped with a single toothed tenaculum. A uterine manipulator was placed into the
endocervical canal and articulated with the tenaculum. The speculum was removed from the vagina.
An infraumbilical incision was made with a scalpel, then while tenting up on the abdomen, a Verres needle was
admitted into the intraabdominal cavity. A saline drop test was performed and noted to be within normal limits.
Pneumoperitoneum was attained with 4 liters of carbon dioxide. The Verres needle was removed, and a 10 mm trocar
and sleeve were advanced into the intraabdominal cavity while tenting up on the abdomen. The laparoscope was
inserted and proper location was confirmed. A second incision was made 2 cm above the symphysis pubis, and a 5
mm trocar and sleeve were inserted into the abdomen under laparoscopic visualization without complication.
A survey revealed normal pelvic and abdominal anatomy. A Falope ring applicator was advanced through the second
trocar sleeve, and the left Fallopian tube was identified, followed out to the fimbriated end, and grasped 4 cm from the
cornual region. The Falope ring was applied to a knuckle of tube and good blanching was noted at the site of
application. No bleeding was observed from the mesosalpinx. The Falope ring applicator was reloaded, and a Falope
ring was applied in a similar fashion to the opposite tube. Carbon dioxide was allowed to escape from the abdomen.
The instruments were removed, and the skin incisions were closed with #3-O Vicryl in a subcuticular fashion. The
instruments were removed from the vagina, and excellent hemostasis was noted. The patient tolerated the procedure
well, and sponge, lap and needle counts were correct times two. The patient was taken to the recovery room in stable
condition.
Estimated Blood Loss (EBL): <10 cc
Specimens: None
Drains: Foley to gravity
Fluids: 1500 cc LR
Complications: None
Disposition: The patient was taken to the recovery room in stable condition.

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2 Postpartum Tubal Ligation Operative Report

Postpartum Tubal Ligation Operative Report

Preoperative Diagnosis: Multiparous female after vaginal delivery, desiring permanent sterilization.
Postoperative Diagnosis: Same as above
Title of Operation: Modified Pomeroy bilateral tubal ligation
Surgeon:
Assistant:
Anesthesia: Epidural
Findings At Surgery: Normal fallopian tubes bilaterally
Description of Operative Procedure:
After assuring informed consent, the patient was taken to the operating room and spinal anesthesia administered.
A small, transverse, infraumbilical skin incision was made with a scalpel, and the incision was carried down through
the underlying fascia until the peritoneum was identified and entered. The left fallopian tube was identified, brought into
the incision and grasped with a Babcock clamp. The tube was then followed out to the fimbria. An avascular midsection
of the fallopian tube was grasped with a Babcock clamp and brought into a knuckle. The tube was doubly ligated with
an O-plain suture and transected. The specimen was sent to pathology. Excellent hemostasis was noted, and the tube
was returned to the abdomen. The same procedure was performed on the opposite fallopian tube.
The fascia was then closed with O-Vicryl in a single layer. The skin was closed with 3-O Vicryl in a subcuticular
fashion. The patient tolerated the procedure well. Needle and sponge counts were correct times 2.
Estimated Blood Loss (EBL): <20 cc
Specimens: Segments of right and left tubes
Drains: Foley to gravity
Fluids: Input - 500 cc LR; output - 300 cc clear urine
Complications: None
Disposition: The patient was taken to the recovery room in stable condition.

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