Uterine Manipulation During Laparoscopic Sterilization-Can we do without it?

Study Objective: To compare complication rates, operative times and costs of laparoscopic tubal sterilization performed without and with uterine manipulation. Design: Retrospective case control analysis of patients who underwent Laparoscopic Tubal Sterilization (LTS). Setting: Bronx Lebanon Hospital Center- a community based teaching hospital, Bronx, New York, USA. Patients: 164 patients who had LTS performed January, 2005 -January, 2013. Intervention: Uterine manipulation to move the uterus during abdominal surgery is a common practice in LTS. Manipulators in our institution include HUMI (Harris-Kronner uterine manipulator injector), uterine manipulator, hulka manipulator, tenaculum with cervical dilator and ring forceps with sponge. Our study compares the outcomes of LTS performed without uterine manipulation compared to LTS with uterine manipulation. Measurements and Main Results: 82 cases of LTS (50%) were performed without uterine manipulation (Group 1), and 82 cases of LTS (50%) with uterine manipulation (Group 2). The groups were matched for Cesarean Sections and general abdominal surgeries. All patients were observed appropriately and discharged the same day of surgery. 1 case in Group 1 required overnight admission for observation after extensive intraoperative adhesiolysis. The average time of LTS surgery was 38.6 (range 20 – 180) minutes in Group 1 and 42.5 (range 12-120) minutes in Group 2. Total numbers of complications in Group 1 were 2 and in Group 2 were 3. Conclusions: Performance of LTS without uterine manipulation from the vagina is a safe alternative for patients desiring LTS. History of previous abdominal surgeries is not a contraindication to performing LTS without manipulation.