Female Sterilization Using the Culdoscope
The culdoscopic method of female sterilizatinn is discussed. The method employs the vaginal approach, and has several advantages over other methods; it leaves no external scar, may be performed with only local anesthesia and analgesia on an outpatient basis, does not require highly sophisticated equipment, can be performed in 10 minutes or less, and is associated with few surgical complications and low postoperative morbidity. Preoperative, operative, and postoperative procedures are described. Any method of tubal occlusion can be combined with culdoscopy, though ligation methods seem simpler and safer than electrocoagulation. It is best to perform culdoscopy 5-6 weeks after childbirth or 2-4 weeks after induced abortion. Major contraindications to the procedure are listed. The few operative complications that may occur include intestinal perforation, bleeding, shock or hypotension, apnea or respiratory difficulties, separation of the 2 layers of the cul-de-sac, and incomplete puncture of the cul-de-sac. Postoperative complications that may occur include shoulder and abdominal pain, fever, infection, abscesses, bleeding, and pelvic inflammatory disease, with pain being the predominant side effect. The reported failure rates for the procedure are 0-2%. Inadequate tubal occlusion accounted for the majority of the failures. Equipment required for the method, and requirements for entering the training programs at Kandang Kerbau Hospital, the University of the West Indies, and the university of Miami are reviewed.