Jack P. Mercer

Laparoscopic sterilization with a spring clip: A report of the first fifty cases

A spring-loaded clip designed to be inserted through a 1 cm. diameter operative laparoscope under local anesthesia has been applied to 50 patients. Forty-three of these patients considered the discomfort of the procedure, including application of the clip onto the tubes, equal to or less than the discomfort of inserting the intravenous needle prior to operation. The procedure has been done on an outpatient basis, with discharge from the hospital within 2 hours of operation. Two patients complained of strong adnexal pain after operation, lasting 48 hours. All patients resumed full household activities and work 2 days after sterilization and were satisfied with the experience. Although the technique compares equally to vasectomy in terms of operative time, patient discomfort, recovery period, and time away from home or work, comparison with respect to medical risk, cost, and effectiveness in preventing pregnancy remains to be established.

Spring clip sterilization: one-year follow-up of 1,079 cases.

This is a report of 1,079 patients who underwent laparoscopic clip sterlization as of March, 1974. A one-year follow-up was obtained on 977 patients, or 90.5 per cent. Complications due to the clip technique appear limited to postoperative cramps for 24 to 48 hours in 26 per cent of patients. No ectopic pregnancies were detected. Pregnancies, when corrected for unsuspected existing pregnancies and surgical and manufacturing errors, occurred in 2 to 6 cases, for a method failure rate of 2 to 6/1,000. This report documents that experienced laparoscopists can perform this practice with local anesthesia, in combination with first-trimester abortion, and in hospital facilities other than an operating room.

Laparoscopic Tubal Clip Sterilization Under Local Anesthesia

Tubal anesthesia with lidocaine during laparoscopic tubal clip appli cation was evaluated in 149 women; 147 tubes received no lidocaine and 151 received 1 or 2 ml of 1% or 4% lidocaine. For unanesthetized tubes the mean pain rating depended on the dose of diazepam and fentanyl given to the patient (p less than .1); pain ratings were higher in women who received no drug. When any diazepam and/or fentanyl was given the anesthetized tubes were given a significantly lower pain rating (p less than .01). 23.8% of unanesthetized tubes received a pain rating of 2 12.9% a rating of 3 or 4 while no anesthetized tube received a 3 or 4 (on a scale of 0 to 4) and only 4% received a 2. 68.5% patients were their own control; 42% rated the pain equal in each tube (1 was anesthetized) while 58% rated the anesthetized tube less painful. 3.4% of the patients experienced vasovagal reflex stimulation. It is concluded that using a local anesthetic solution substantially reduces discomfort associated with fallopian tube manipulation during sterilization.

Outpatient laparoscopic sterilization with therapeutic abortion versus abortion alone.

Records of 108 patients undergoing combined vacuum aspiration and laparoscopic sterilization in an outpatient surgical program were reviewed and compared with those of 195 patients who underwent abortion only in the same outpatient program. Mean operating time for the combined procedure was 30 minutes; total mean hospitalization time was 5 hours and 7 minutes. Complication rates for the combined procedure and for abortion alone were 9.2 and 7.2 per cent, respectively. Subsequent hospitalization was necessary for 4.7 per cent of patients undergoing the combined procedure and 3.1 per cent of those having abortion only. Laparoscopic sterilization has been found to add no significant morbidity but has markedly reduced cost and hospitalization for the patient desiring permanent contraception following first trimester abortion.

Regional Training Program of Laparoscopy: Impact on Regional Care

In response to large numbers of requests for laparoscopic sterilization, the University of North Carolina began a training program to provide this service on a regional basis throughout the state. This report reviews the final distribution of centers providing these services: one within 50 miles of every person in the state. The clinical experience of 30 private physicians (excluding experience of residency training programs) was reviewed and found to parallel the national experience in provision of services, in complications, and in pregnancies. The brief but intense training program (2 days at the University of North Carolina and one morning at the physicians hospital) was found to result in rates of complications and failures similar to national levels of performance. Should the demand for laparoscopic sterilization increase in the coming years, the region has sufficient numbers of safely trained physicians to respond.

Spring Clip Tubal Occlusion: A Report of the First 400 Cases *

Between September 1972 and March 1974, laparoscopic tubal sterilization was performed on 394 patients with the use of a spring-loaded plastic clip under local analgesia and on an outpatient basis. Intravenous fentanyl and infra-umbilical infiltration and tubal spray with 1% lidocaine were found to be very acceptable and effective forms of analgesia. The average time spent by a patient in the hospital was 4 hours, 26 minutes. There was no major immediate complications apart from vasovagal reactions in 34 patients. Up to June 30, 1974, six patients in the series had become pregnant, not as a failure of the clip per se, but as a result of improper application of the clips. This seems to be a safe, simple, and effective method of female sterilization with great potentials of reversibility.

Practicability of ultrasonography for assessing fetal age and weight in early pregnancy.

Mercer, J. P., Brenner, W. E., Bolan, J. C., Dingfelder, J. R., Edelman, D. A. and Staurovsky, L. G. (Dept. of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC 27514, and International Fertility Research Program, Research Triangle Park, NC 27709, USA). Practicability of ultrasonography for assessing fetal age and weight in early pregnancy.

LAPAROSCOPIC TUBAL CLIP STERILIZATION UNDER LOCAL ANESTHESIA

Tubal anesthesia with lidocaine during laparoscopic tubal clip appli cation was evaluated in 149 women; 147 tubes received no lidocaine and 151 received 1 or 2 ml of 1% or 4% lidocaine. For unanesthetized tubes the mean pain rating depended on the dose of diazepam and fentanyl given to the patient (p less than .1); pain ratings were higher in women who received no drug. When any diazepam and/or fentanyl was given, the anesthetized tubes were given a significantly lower pain rating (p less than .01). 23.8% of unanesthetized tubes received a pain rating of 2, 12.9% a rating of 3 or 4, while no anesthetized tube received a 3 or 4 (on a scale of 0 to 4) and only 4% received a 2. 68.5% patients were their own control; 42% rated the pain equal in each tube (1 was anesthetized), while 58% rated the anesthetized tube less painful. 3.4% of the patients experienced vasovagal reflex stimulation. It is concluded that using a local anesthetic solution substantially reduces discomfort associated with fallopian tube manipulation during sterilization.