Laparoscopic tubal ligation. A follow-up report on the Yoon falope ring methodology.
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A technique using a low-voltage, rechargeable battery pack and a cautery hook assembly for thermal coagulation and division of the fallopian tube under laparoscopic visualization has been evaluated in 393 patients. The procedure is quick, easy to perform, and electrically safe. The gross extent of the burn to the fallopian tube by thermal coagulation and division was compared with that done by high-frequency unipolar electrocoagulation and division. The difference in the mean total gross tubal burn produced by the 2 methods is not statistically significant. The variance of total tubal burn in individual cases within each group is significantly greater in the electrocoagulation group. The authors assume that pregnancy rates in patients undergoing thermal coagulation and division will be no different than those reported in patients in the electrocoagulation and division group. Two hundred of the patients have been followed from 12 to 33 months and no method-failure pregnancies have occurred.
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For the evaluation of the effectiveness of contraceptives the Life Table method is at present the best method. It is a disadvantage that the original method of Tietze & Potter was restricted to the evaluation of intra-uterine contraception devices. A Belgian team is now in the process of developing a modified life table method for the evaluation of the effectiveness and the side effects of oral contraceptives. The reference to the Pearl-index for the effectiveness of contraceptives is unclear and in the way in which it is at present used scientifically untenable.
A modified technique of two-layer microsurgical vasovasostomy is described which permits continuous inspection of the lumen. A stricture-free anastomosis was documented in experimental animals by mating and scanning electron microscopic studies. The success of this procedure is attributed to precise placement of fine mucosal sutures, minimal fibrosis, and a fluid-tight anastomosis.
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The ability of tuboplastic microsurgery to restore electrical continuity across an anastomosis site was investigated in the rabbit. Three to six weeks following transection and end-to-end anastomosis of the tubal ampulla or isthmus, the pattern of electrical activity adjacent to and across the anastomosis site was examined. Recordings were made in vitro using arrays of closely spaced suction electrodes 68 to 72 hours after an ovulating dose of human chorionic gonadotropin. The pattern of electrical activity across anastomosis sites was not significantly different from corresponding portions of unoperated control oviducts. Microsurgical anastomosis restored electrical continuity between anastomosed segments in both the ampulla and isthmus.