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Surgical Video – Minilaparotomy Technique for Postpartum Tubal Ligation
This video demonstrates an effective and efficient technique for getting into the abdomen for a postpartum tubal ligation or open laparoscopy in any patient, big or small, in no time at all.
Categories: Surgical Videos
Academic OB/GYN 
postpartum and interval tubal ligation, what is the difference in incision part? can you provide the video too ?
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Interval tubals are generally peformed laparoscopically.
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Is there any reason why a postpartum tubal cannot be done laparoscopically? Especially with the Hassan (sp?) technique, which you mentioned? And especially if using Filschie clips? I have not had a particular problem getting in…I do it exactly like you do. The problem can be extracting the tubes after entry.
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Do you ever have trouble getting a Filshie clip around a edematous postpartum tube? I’ve used Filshies for interval tubals but never for a postpartum one.
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No, not with the Filshie. I stopped using Hulkas for PPBTL’s and at C-sections when I was getting ready to close a C-section and saw one of the clips floating by. If you look at the construction of the Hulka vs. the Filshie, you can see the advantage of the latter. I’m pretty sure that the Filshie people advocate its use for PPBTL.
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Why do it laparoscopically when the tubes are right at the incision site? I agree that it can be a challenge to get to the tubes through the umbilicus, but I’ve never not been able to do it.
A few tips I teach my residents:
1) move the incision to the tubes, don’t try to bring the tubes to the incision
2) if you can find a round ligament, grab it with a babcock and use it to pull the uterus and expose the tubes
3) use a wet raytec and a long forcep to pack the omentum away from the tube. Once the raytec is almost all in there put it behind the army navy retractor to hold it out of the way
4) sometimes a finger on the uterus to push it over can do wonders
5) make sure the bladder is empty. if its really full it can move the tubes up high away from the incision.
At this point I don’t really ever have much trouble getting the tubes. One of these tricks or another always works. I’ve never had the need to do a laparoscopy for a postpartum tubal. If I had that much trouble I’d probably just put in a Mirena at the postpartum visit or do an Essure procedure.
Thanks for the comment!
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Thanks! Keep on the good work
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Have you ever used the Alexis (mini) retractor for postpartum tubals? I am generally not one for expensive disposable new devices that aren’t really filling a need, but I have to say, this one is awesome! It’s probably not so relevant in a teaching hospital with residents/students, but in private practice, it’s just me and a scrub tech. It takes a moment to get it set up, then you can just use one army-navy to move the “porthole” over to the first side. I do believe it saves me time, know that it saves frustration.
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I’ve never done that, never lacking for a resident or medical student to hold the army navy retractors, but I don’t doubt it would work well. They’re surprisingly cheap as well, only about $40.
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