Laparoscopy Tubal Ligation-Tubectomy

Laparoscopy Tubal Ligation or tubectomy is a surgical procedure used to block the transfer of ova through the fallopian tube and prevent the pregnancy or implanting the ova into the uterus

Indication

Birth control plans

To control the pregnancy to avoid the risk of severe disease like chronic kidney disease, heart disease, etc.

Tubal ligation requirements

General Instruments

#15 scalpel with #3 BP handle

Artery forceps

Allis forceps

Adson tissue holding forceps

Needle holder

Kidney tray

Bowl sponge holder

Laparoscopy instruments

10mm trocar port

5mm trocar port

J tip laparoscopy suture

Dermabond/Steristrips for skin closure

Babcock forceps

Metzenbaum scissors

Maryland forceps

Light source cable

Gas tube for insufflation with CO2 insufflator

Position

Patients positioned in lithotomy position for laparoscopy tubal ligation procedure

and followed by Trendelenburg position

Anesthesia

General anesthesia

1 % lidocaine local infiltration of local anesthesia drugs on the surgical site of incision

Tubal ligation surgery

Incisions made on the abdomen with the #15 scalpel handle and dissect with artery forceps.

Using Verre’s needle, create the pneumoperitoneum using CO2 insufflator

Introduce the trocar by grasping the muscle together while insertion

Camera port ready for the insertion of a telescope with camera for visualization

Make one more incision for the working channel

A surgical assistant from the perineal site drains the bladder and lift the uterus using the uterine manipulator

The surgeon once differentiated the fallopian tube and check for adhesion and dissection starts with a monopolar hook if needed

Use the atraumatic Babcock forceps for lifting the fallopian tube and clip or use the O ring to achieve the blockage of the tube

Read more about Tracheostomy

Tubal ligation types and methods

  1. Dissection and ligation method
  2. Fallopian O ring method
  3. Filchie clip method

Dissection and ligation

Just cut the fallopian tube after the clamping and ligate it using bipolar forceps.

Fallopian O ring method

The ready-made ring made of silastic material for the application on the loop of the fallopian tube.  The ring applicator itself creates the loop by manual action and application of O ring achieved.

After the ring applied, the fallopian tube site necrosis starts and blockage of fallopian is achieved without fails

Make sure the clip applied tight and proper manner after application

Filchie clip method

Clip application in between of fallopian tube using clip applicator. The clip must be applied on the two sites leaving a 0.5mm gap for ligation

After application of the clips, cut with the Metzenbaum scissors for cutting the tube in between the clips applied

The clips applicator used to apply the clip made of absorbable material.

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