Tubal Ligation – Laparoscopic Silastic Band Technique

Surgical Details of Tubal Ligation

In tubal ligation:

1. The patient is placed supine on the operating table with legs placed in stirrups

2. A Jacobs tenaculum is inserted into the vagina and is used to grasp the cervix so the uterus can be antiflexed (tipped up).

3. A periumbilical port is placed. Although most general surgeons performing tubal ligation have abandoned the use of the Veress needle to enter the abdomen, some gynecologists still use this technique.

tubal ligation veress needle

Veress needle used in laparoscopic surgery

4. The Veress needle is inserted into the peritoneal cavity by grasping the area around the umbilicus and retracting it upward with a “blind stick” into the peritoneal cavity.

5. When placing the needle into the cavity the experienced clinician will ascertain two discrete “pops” as the needle goes through the tissue layers.

6. Most clinicians performing tubal ligation then open the needle to allow fluid flow through the lumen and then place several cc’s of sterile saline into the needle to insure that it drains rapidly and suggests that the tip of the needle is free in the peritoneal space.

7. Insufflation of the abdomen is then performed by attaching the carbon dioxide line to the side port of the needle.

8. The intraperitoneal pressure is allowed to rise to 15 mm Hg.

9. The Veress needle is then removed and a 10 mm umbilical port with trochar is inserted blindly into the peritoneal space.

10. The inner trochar is removed and the cap is placed onto the port.

11. The laparoscopic camera is placed through the port and visual inspection of the abdominal cavity is performed.

12. A lower midline port is placed via the trochar maneuver under direct visualization of the laparoscopic camera.

13. The uterus is antiflexed by manipulating the previously placed Rubin’s cannula and Jacobs tenaculum.

14. The tongs of the Silastic band instrument is loaded with a Fallope-ring and inserted into the abdomen.

15. The fallopian tube is drawn into the Silastic band applicator with care taken to not draw too much much fallopian tube tissue into the housing of the the banding scope to prevent laceration of the fallopian tube.

16. The “knuckle” of fallopian tube tissue is drawn into the Silastic band applicator.

17. The Fallope-ring is pushed off the applicator onto the grasped tissue.

18. The contralateral (opposite side) fallopian tube is located and the above steps are repeated.

19. To begin the surgical closure in tubal ligation, the pelvic area is thoroughly inspected to insure there is no hemorrhage.

20. The instruments are withdrawn through the trocar sites.

21. Gentle pressure is placed on the outside of abdominal wall to express any remaining pneumoperitoneum (carbon dioxide left in the abdomen).

22. The abdominal port site is then closed by placing hemostats on the fascia and retracting up into the would to allow for placement of an abdominal closure suture such as PDS to prevent an umbilical hernia from closing.

23. The skin for the port sites is closed using a subcuticular monocyrl or skin staples.

Written by