Laparoscopic tubal sterilization

Laparoscopic tubal sterilization is also called laparoscopic sterilization, which can be divided into electrocoagulation sterilization and mechanical sterilization. Electrocoagulation sterilization is divided into monopolar coagulation and bipolar coagulation. The former has a low incidence of complications due to electrical burns and is rarely used. The mechanical sterilization method is divided into a silicone rubber ring ligation method and a spring clamp method. Curing disease: Indication 1. Both married couples and couples require sterilization. 2, due to systemic diseases or certain genetic diseases are not suitable for childbearing. 3, again cesarean section. Contraindications Absolute contraindication (1) History of multiple abdominal surgery or extensive abdominal adhesions. (2) History of acute pelvic inflammatory disease or total peritonitis. (3) History of excessive flatulence and intestinal obstruction. (4) A history of sputum in the abdominal wall, hernia, esophageal hiatus hernia, umbilical hernia, inguinal hernia, etc. (5) History of blood disease or bleeding tendency. (6) severe neurosis or snoring. (7) Patients with severe cardiovascular disease, those with poor lung function (difficulty in breathing after breathing in the abdominal cavity, or even the risk of heartbeat). 2. Relative contraindications (1) Previous history of abdominal surgery, such as appendectomy, laparotomy, cesarean section, ovarian cystectomy and cholecystectomy. If the operation is successful, no incision infection after surgery, it is estimated that there is no serious abdominal adhesion, laparoscopic sterilization is generally not encountered difficulties. (2) History of localized peritonitis. Preoperative preparation 1. Preparation of items such as laparoscopy and related special equipment. Check whether the power supply of the laparoscope is normal, and the dressing is basically the same as that of the abdominal fallopian tube. Surgical instruments are different due to different ligation methods. (1) Ligation method: 2 syringes of 10 ml, 1 needle of local anesthesia, 1 set of short toothed scorpions, 1 small curved disc, 1 pair of scissors, blades and handles, 1 needle holder, 2- 0 or 3-0 gut 1 tube, 2 cloth towel pliers, 2 tissue forceps, 1 straight hemostatic forceps, 1 vaginal speculum, 2 oval needle clamps for disinfection, 1 uterine device, double ring ligation 1 set, Falope silicone rubber 2 only. (2) Spring clip method: the instrument is the same as the ligation method, and the double ring ligature device is changed into the upper clamp and the spring clamp. (3) Bipolar coagulation method: The instrument is the same as the ligation method, and the special instrument is a bipolar coagulator. 2, with the abdominal tubal ligation. 3, chest and electrocardiogram examination, check blood type. 4, the abdomen preparation of the skin, the umbilical part is the incision site, special care must be taken to clean. Surgical procedure 1, bladder lithotomy position and low arm height, routine disinfection of the vulva, placed in the uterine cavity, placed in the uterine cavity, in order to raise and rotate the palace, easy to operate. 2, according to the routine operation of laparoscopic surgery. 3. Treatment of fallopian tubes: 1) Electrocoagulation sterilization (1) Grab the fallopian tube with a grasping forceps, use an electric coagulator to energize the fallopian tube, destroy or block the fallopian tube lumen to achieve sterilization purposes. (2) 2 to 4 cm outside the uterine horn, the fallopian tube isthmus is clamped by the electric coagulation clip, and the electrocoagulator is energized to cause local high temperature formation, causing tissue coagulation, dehydration, scorch, destruction of the fallopian tube 5-6 mm, electrocoagulation to make the fallopian tube Blocking and sterilization. Electrocoagulation sterilization is currently carried out by bipolar coagulation. That is, the two leaves of the grasping forceps are absolutely insulated to become the yin and the anode. Because of the resistance of the trapped tissue, when the current flows between the two leaves of the grasping force, local high temperature causes the tissue to coagulate. , dehydration, and scorch. The operation is fast and the postoperative pregnancy rate is low. 2) Internal agglutination (1) One of the bipolar coagulator grippers is changed to a metal heating plate, and the other leaf is only used to clamp the oviduct tissue, and after the energization, osmotic heat energy is generated between the two leaves. (2) Two points of the fallopian tube at 2 to 4 cm from the uterus were condensed with crocodile mouth pliers. The coagulation area at each point was 4 mm. The crocodile mouth pliers were removed and the coagulation area was cut with a hook. 3) The ring sterilization ring is made of special silicone rubber, containing 5% barium sulfate, inner diameter of 1mm, outer diameter of 3.5mm, thickness of 2.2mm, with 100% elastic memory, and can be expanded to 6mm. It is placed with a special double-cylinder ferrule, and its outer cylinder is shorter than the inner cylinder by 5 mm. The outer cylinder can be pushed flush with the inner cylinder, and the tube is equipped with a fallopian tube hook. The hook can be extended or retracted into the barrel. The tip of the special plastic conical dilator is placed on the silicone ring, the bottom of which is sleeved into the inner tube of the ring, and then the silicone ring is pressed successively toward the bottom of the cone to fit over the inner tube of the collar. Select the 3 to 4 cm of the fallopian tube isthmus, push the fallopian tube hook, lift the fallopian tube to form the fallopian tube sputum, then retract the fallopian tube hook, slowly pull the fallopian tube into the lens barrel, push the collar and bundle it on the fallopian tube. 4) Tubal clip sterilization (1) Use a special placer to place the fallopian tube clip through the laparoscope on the fallopian tube for sterilization purposes. Commonly used are Hulka clips and Filshie clips. (2) Use the placer to clamp the spring clamp to the isthmus of the fallopian tube, push the spring to lock the clip to avoid slipping, and then release the placer, that is, leave the clip on the fallopian tube. The placer is removed in a closed manner. 4, check the surgical field of view and pelvic organs, if there is no abnormality, shake the lower breech position, release the carbon dioxide gas in the abdominal cavity, take out the outer cannula. 5, suture the fascia and a needle in the skin with a thin gut line or a thin wire.