A guide to sterilization procedures.

The history of female sterilization procedures is reviewed from earliest U.S. pioneers of tubal sterilization (Lundgren in 1880) through subsequent technique modifications including Madlener in 1919 Irving in 1924 Pomeroy in 1929 Aldridge in 1934 Kroener (fimbriectomy) in 1955 and Uchida in 1960. Figures show the differing tubal ligation techniques and positions for all procedures. The tubes may be approached by conventional laparotomy minilaparotomy colpotomy or endoscopy. Of the endoscopic techniques laparoscopy is the most widely used with various tubal occlusion methods. The 1st tubal occlusion using simple electrocoagulation under laparoscopic control was performed in the U.S. in 1937 by Anderson. Various coagulation positions on the tubes and types of current (unipolar and bipolar) available are pictorially presented. Alternative methods developed to avoid electrical injury to the patient during electrocoagulation are described and the bipolar procedure is cited as safer than the unipolar because the danger of sparking is eliminated. 2 nonelectrical laparoscopic techniques of tubal occlusion now popular use spring-loaded clips or loop strangulation of the tube. As sterilization is considered more for interval rather than permanent contraception reversibility of procedures must be ascertained. To date no procedure is close to 100% reversible with the nonelectrical occlusive techniques holding the most hope. However these procedures are the most expensive and require the most sophisticated instrumentation and personnel. Research should aim at improving techniques that provide complete tubal occlusion with minimal tissue destruction; until such procedures are established promotion of certain sterilization techniques as reversible (e.g. laparoscopic tubal sterilization) should be viewed as a form of coercion.