Tubal Sterilization: Review of methods

Methods available for female tubal sterilization are reviewed. The development of endoscopic equipment and special cannulae has permitted a variety of approaches to female sterilization. Laparotomy, which requires a large abdominal incision, has been replaced by minilaparotomy (small abdominal incision), laparoscopy (abdominal puncture), colpotomy and culdoscopy (vaginal approach), or hysteroscopy (transcervical approach). Procedures reviewed involving tubal ligation include simple ligation, the Madlener technique, the Irving technique, the Wood technique, salpingectomy, the Pomeroy technique, fimbriectomy, cornual resection, and the Uchida technique. Laparoscopic and hysteroscopic fulguration, tubal occlusion with tantalum clips, spring-loaded clips, plastic clips, and the falope ring, plugs, chemical tubal occlusion (quinacrine, silver nitrate, silastic, methyl 1-2-cyanoacrylate, gelatin-resorcinol-formalde hyde), and experimental methods such as fimbriectomy and carbon dioxide laser are reviewed, and their advantages and disadvantages are outlined. Endoscopic techniques generally require more skill and training than other techniques, while transcervical approaches are considered to be in the experimental stage. Electrocautery and some chemical methods are more likely to damage structures adjacent to the tubes than other methods. Infection occurs more frequently with vaginal methods than abdominal methods. Morbidity is more frequently associated with ligation techniques than those in which the continuity of the tube is maintained. Anastomosis is most successful in cases of tubal ligation, though a full assessment of plugs in this respect has not been done.

Johns Hopkins Bloomberg School of Public Health,Center for Communication Programs,Population Information Program