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Fallopian Tubes
and Ovaries

Laparoscopy Technique

Diagnostic Uses
of Laparoscopy

of Tubal Patency
via Laparoscopy

Laparoscopic Resection
of Unruptured
Ectopic Pregnancy

Ovarian Biopsy
via Laparoscopy

Electrocoagulation of
Endometriosis via

Lysis or Adhesions
via Laparoscopy

Control of Hemorrhage
During Laparoscopy

Fallopian Tube

Sterilization by
Electrocoagulation and
Division via Laparoscopy

Silastic Band Sterilization
via Laparoscopy

Hulka Clip Sterilization
via Laparoscopy

Sterilization by the
Pomeroy Operation

Sterilization by the
Modified Irving Technique

Sterilization by the
Minilaparotomy Technique

Sterilization - Ucheda Technique




Tuboplasty -
and Anastomosis
of the Fallopian Tube

Wedge Resection
of the Ovary

Torsion of the Ovary

Ovarian Cystectomy

Sterilization by Electrocoagulation
and Division
via Laparoscopy

Electrocoagulation and division of peritoneal structures via the laparoscope are facilitated if the surgeon achieves adequate displacement of the intestine out of the pelvis, maintains a clear pneumoperitoneum free of smoke, and ensures that the installation of the electrocoagulating instrument is advanced sufficiently to prevent contact between the instrument and the tip of the laparoscope. These principles are valid whether performing sterilization, fulguration of endometrial implants, biopsy of the ovary, or lysis of adhesions.

The purpose of the operation is to provide a simple method of female sterilization by electrocoagulation of the Fallopian tube via the laparoscopic technique.

Physiologic Changes. After the electrofulgurated and divided tube heals, migrating spermatozoa should not be transported through the Fallopian tube. Oocytes entering the distal end of the tube should not pass the point of obstruction.

Points of Caution. The surgeon must adhere to the points of caution noted for the laparoscopy technique described in the section on Ovarian Biopsy by Laparoscopy.

There is the additional risk with electrocoagulation of inadvertently burning the intestine. Even with utmost care and attention to detail, the surgeon cannot always prevent some electrocoagulation burns of the bowel. Care should be taken, however, to ensure that the insulation on the grasping forceps is well beyond the point of the metal trocar or laparoscope. In addition, the structure being electrocoagulated should be moved well away from the adjacent bowel or bladder.


Sterilization by electrocoagulation can be achieved by either extensive electrocoagulation of the tube alone or electrocoagulation and division. Experience has shown a lower failure rate when the tube is electrocoagulated and divided. Use of electrocoagulation and division increases the possibility of hemorrhage from the mesosalpinx, however, if sufficient electrocoagulation has not been performed prior to division of the tube. The uterus is markedly anteflexed and deviated to one side, placing the tube on a slight stretch. The tube is grasped in the ischemial portion approximately 3 cm from the cornua of the uterus.

The tube is elevated and placed in a position that is free from contact with bowel or bladder.

The electrocoagulation forceps is checked to be sure that insulation is clearly visible and that the metal grasping jaws of the coagulation forceps are not in contact with the laparoscope or the trocar sleeve of the second-incision instrument. The current is turned on, and the tube is thoroughly electrocoagulated for at least 5 full seconds. Frequently, the tube will swell and make a popping noise, indicating that fluid within the lumen of the tube and tubal cells has reached the boiling point. The burn will spread over a finite area, usually 3-4 cm along the tube and 2 cm into the mesosalpinx. The burn will not spread farther because burned tissue has greater resistance to the flow of electrical current than does normal tissue. When the tube has collapsed from its swollen state, it has been coagulated sufficiently.

At this point, the tube is avulsed off the mesosalpinx and from its connection to the proximal and distal tube. This is facilitated by shearing the tube against the operative port of the laparoscope. The reduced tensile strength of the burned tube has little resistance to the tearing motion of the grasping forceps.

Care should be taken to ensure that insulation is showing through the laparoscope at all times. It is a mistake for the metal of the grasping forceps to make contact with the metal end of the laparoscope. This may allow the electrothermal energy to flow up the shaft of the laparoscope and may produce a burn of the intestine higher in the abdomen.


Copyright - all rights reserved / Clifford R. Wheeless, Jr., M.D. and Marcella L. Roenneburg, M.D.
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