Minilaparotomy and endoscopic techniques for tubal sterilization
RHL practical aspects by Peterson HB
The Cochrane Review addresses only the evidence for morbidity from three surgical approaches to tubal sterilization: it does not evaluate an intervention per se.
FIRST CONTACT (PRIMARY CARE) LEVEL
At the primary health care level or at outpatient clinics it is unlikely that sterilizations will be performed. The main responsibility of health workers at this level of care with regard to sterilization is to help women and couples make informed decisions in choosing a method of contraception. Sterilization is appropriate only when permanent contraception is desired and when the person considering sterilization fully understands not only the intended permanence of the procedure but also the advantages and disadvantages of the method versus nonpermanent methods. Women and couples considering tubal sterilization should understand that, while tubal sterilization in general is safe and highly effective, observational studies suggest that vasectomy is generally somewhat safer and more effective (1). They should not only fully understand the anticipated risks and benefits of sterilization, but also that they need to be fit for surgery.
REFERRAL HOSPITAL (SECONDARY CARE) LEVEL
Tubal sterilizations are most likely to be performed at the secondary care level. While some of the clinics at this level may have the capacity to purchase, maintain and appropriately use laparoscopic equipment, and have surgeons specially trained in laproscopic sugery, others will not – particularly those in under-resourced settings. The evidence from this review is insufficient to provide a compelling reason for facilities already safely providing minilaparotomy services to switch to the laparoscopic approach. Rather, whether minilaparotomy or laparoscopic services are provided, ongoing efforts should strive to assure that tubal sterilization, a generally safe and highly effective procedure, becomes even safer and more effective.
AT HOME OR IN THE COMMUNITY
Sources of support: None.
- Huber DH. Vasectomy. An appraisal for the obstetrician-gynecologist. Obstetrics and gynecology 1990;76:568-572.
This document should be cited as: Peterson HB. Minilaparotomy and endoscopic techniques for tubal sterilization: RHL practical aspects (last revised: 23 June 2009). The WHO Reproductive Health Library; Geneva: World Health Organization.