Minilaparoscopy with local anaesthesia: an even less invasive surgery for
J.F. Garrido, P. Deulofeu, M. Colodrón
Department of Gynaecology, Municipal Hospital of Badalona, Spain
Introduction: Fallopian tubes sterilization is the most popular choice
for definitive female contraception. Local anaesthesia (LA), with or without
intravenous sedation, has been used in the last 25 years in this procedure.
However, this intervention is usually made under general anaesthesia (GA) in our
country. After 133 laparoscopic procedures in the Ambulatory Surgery (AS) Unit,
we considered the possibility of making tubal ligation under LA and intravenous
sedation, based on two important facts: we had the availability of a
minilaparoscope (3,3 mm scope, 3 mm tools) and we deal with the necessity of
reducing the postoperative stay in the recovery of the AS Unit. We present a
retrospective five years study of the results of our cases of sterilization with
minilaparoscopy under LA.
Aims and Methods: 1846 gynaecologic surgical procedures were made
between 1999 and 2003 in our Department; 697 of them in the AS Unit (38%). We
made 228 laparoscopic tubal interruptions in these years, 100 of them (44%) as
Ambulatory Surgery cases. Patients included in the minilaparoscopy group must
not be obese, be interested in avoiding GA and sign the informed consent. 29
patients underwent tubal sterilization under LA and were included in this study.
After local injection of mepivacaine or bupivacaine in the umbilicus and
suprapubic zone, and in uterine cervix, a carbon dioxide pneumoperitoneum was
induced up to 6–8 mmHg. Slight Trendelenburg position was made. Fallopian
tubes were electrocoagulated with a bipolar forceps and afterwards sectioned.
Results: 3 of the 29 procedures began with GA, as the presence of
adhesions because of previous operations was suspected. 15 of the 26 procedures
beginning with LA and sedation were completed. 11 cases had to be finished under
GA, 6 of them because of the pain of the patient and 5 as a consequence of
technical failures. These failures were a bad evaluated obesity; a preperitoneal
false way of the port; no vision of fallopian tube in one case, and two cases of
breakdown of the bipolar forceps
Conclusions: Tubal ligation under LA with minilaparoscopy is useful to
selected patients, and has to be included as an Ambulatory Surgery indication.
This method provides a good quality view, but reduced visual field. Surgeons
have to be trained to develop a careful proceeding and to manage with
limitations like an undersized visual field and a slight Trendelenburg position.