Uterine Manipulation During Laparoscopic Sterilization-Can we do without it?

Research Article

Austin J Womens Health. 2014;1(1): 3.

Uterine Manipulation During Laparoscopic Sterilization-Can we do without it?

Prasad P, Agochiya J* and Hecht RM

Department of Obstetrics and Gynecology, Bronx Lebanon Hospital, USA

*Corresponding author: Agochiya J, Department of Obstetrics and Gynecology, Bronx Lebanon Hospital, USA

Received: September 10, 2014; Accepted: October 16, 2014; Published: October 18, 2014

Abstract

Study Objective: To compare complication rates, operative times and costs of laparoscopic tubal sterilization performed without and with uterine manipulation.

Design: Retrospective case control analysis of patients who underwent Laparoscopic Tubal Sterilization (LTS).

Setting: Bronx Lebanon Hospital Center- a community based teaching hospital, Bronx, New York, USA.

Patients: 164 patients who had LTS performed January, 2005 -January, 2013.

Intervention: Uterine manipulation to move the uterus during abdominal surgery is a common practice in LTS. Manipulators in our institution include HUMI (Harris-Kronner uterine manipulator injector), uterine manipulator, hulka manipulator, tenaculum with cervical dilator and ring forceps with sponge. Our study compares the outcomes of LTS performed without uterine manipulation compared to LTS with uterine manipulation.

Measurements and Main Results: 82 cases of LTS (50%) were performed without uterine manipulation (Group 1), and 82 cases of LTS (50%) with uterine manipulation (Group 2). The groups were matched for Cesarean Sections and general abdominal surgeries. All patients were observed appropriately and discharged the same day of surgery. 1 case in Group 1 required overnight admission for observation after extensive intraoperative adhesiolysis. The average time of LTS surgery was 38.6 (range 20 – 180) minutes in Group 1 and 42.5 (range 12-120) minutes in Group 2. Total numbers of complications in Group 1 were 2 and in Group 2 were 3.

Conclusions: Performance of LTS without uterine manipulation from the vagina is a safe alternative for patients desiring LTS. History of previous abdominal surgeries is not a contraindication to performing LTS without manipulation.

Keywords: Laparoscopic; Tubal; Sterilization

Abbreviations

LTS: Laparoscopic Tubal Sterilization; HUMI: Harris-Kronner Uterine Manipulator Injector

Introduction

Female sterilization is the most widely used method of contraception in the world and in the United States of America [1] of which laparoscopic tubal sterilization is the preferred method. It is a safe and effective method (annual failure rate of 0.55 at year 1 and 0.13 at year 5 of use [2]) of preventing unintended pregnancies, since such pregnancies are associated with substantial adverse health, social and economic consequences. LTS has been performed in many different ways, of which bipolar cauterization of the Fallopian tube is a commonly performed procedure [3]. This procedure includes manipulation of the uterus by insertion of a cervico-uterine instrument. We conducted a retrospective case-control analysis of this method of LTS, without and with uterine manipulation in order to determine whether LTS without uterine manipulation was a safe and cost–effective technique.

Materials and Methods

This study includes 164 women between the ages of 23 and 48 years who underwent laparoscopic sterilization from January, 2005 to January, 2013 at the Bronx Lebanon Hospital, New York, USA.

The patients who underwent LTS without uterine manipulation were matched in terms of age and parity with those that had the procedure without uterine manipulation. (Case control analysis).

Results

The age range of the patients was 26-46 years in Group 1 with a Median of 36 years and 23-48 years with a median of 35.5 years in Group 2. The parity had a Range of 1-5 (median 3) in Group 1 and a Range of 1-6(median 3.5) in Group 2. In Group 1, 16 had previous general abdominal and 26 patients had >1 Cesarean Sections. In Group 2 16, had a history of previous abdominal surgery and 18 patients had had >1 Cesarean Sections. The average time of LTS surgery was 38.6 (range 20 – 180) minutes in Group 1 and 42.5 (range 12-120) minutes in Group 2. 1 case in Group 1 required overnight admission for observation after extensive intraoperative adhesiolysis. Total number of complications in Group 1 was 2 and in Group 2 were 3. Complications in Group 1 were: 1 hematoma noted at the 5 mm entry port controlled with electrical cauterization, and 1 small bowel injury noted after entry (treated laparoscopic ally). Complications noted in Group 2 were: 1 case of bleeding from the tenaculum site (controlled with cauterization), 1 case of ovarian dermoid cyst rupture leading to cystectomy, 1 case of uterine perforation (managed by laparoscopic cauterization of perforation site). There were no cases of conversion to Laparotomy in either group.

Citation: Prasad P, Agochiya J and Hecht RM. Uterine Manipulation During Laparoscopic Sterilization- Can we do without it?. Austin J Womens Health. 2014;1(1): 3.