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 Modified
The modified Irving operation was proposed to prevent
the small but persistent incidence of failures associated with the
Pomeroy procedure. Although prospective randomized studies are unavailable
at this writing, this operation is regarded as one of the most effective
for prevention of pregnancy.
The purpose of the procedure is to prevent
pregnancy by obstructing the Fallopian tubes by burying their proximal
portions back into the myometrium.
Physiologic Changes. The
physiologic changes with the modified Irving technique are similar
to those associated with the other methods of tubal obstruction and
ligation. In addition, the proximal portion of the Fallopian tube
is buried within the myometrium. This makes recanalization or the
development of a tuboperitoneal fistula extremely unlikely.
Points of Caution. An adequate opening in the myometrium
must be made with the straight mosquito clamp if the Fallopian tube
is to be pulled within the myometrium.
The abdomen is opened through a transverse
or lower midline incision. The Fallopian tube is grasped with
an Allis or a Babcock clamp. A small Halsted hemostat is used
to open the mesosalpinx.
Two 0 synthetic absorbable sutures are passed
through this opening.
The sutures are tied, and the segment of
Fallopian tube is transected and removed. The tie on the distal
segment of the proximal portion of Fallopian tube is threaded
onto two French eye needles.
A mosquito hemostat is used
to open a 6-mm defect in the posterior wall of the uterus in
the cornual region.
The French eye needles are passed
through this defect, one after another, and the suture is tied,
pulling the proximal portion of the Fallopian tube into the defect.
The completed operation shows
both proximal portions of the Fallopian tube buried within
the myometrium. The distal portions of the Fallopian tube are
ligated and left in place.
The abdomen is closed in layers.