A 37-year-old woman P3L3 attains Family planning Clinic with a strong desire for female sterilization

A 37-year-old woman P3L3 attains Family planning Clinic with a strong desire for female sterilization. She gives history,that previous deliveries are caesarean deliveries…
She also gives history of
Intra Caeserean insertion of IUCD during her second delivery.
Following 2 years of insertion ,She underwent laparoscopic retrieval of IUCD due to perforation …

Recently ,she has had a ruptured appendicitis …

On examination(GPE) ,
BP=120/90mmhg,
PR=86bpm…
Mildly anemic …
No other significant findings …

Per abdomen examination reveals multiple abdominal scars noted …

No significant Pelvic examination findings …

Which of the following
is the best surgical approach in this patient?

A. Laparoscopic Falope ring

B. Laparoscopic electrocautery

C. Hysteroscopic approach

D. Minilaparotomy with tubal occlusion…


Answer: “C” Hysteroscopic approach

Here ,the patient underwent

  1. 2 caesarean sections
    2)Laparoscopic surgery(IUCD retrieval)
    3)surgery for ruptured appendicitis…

Nearly 3 to 4 abdominal scars …
Such abdomen is not suitable for laparoscopy, Minilaparatomy…

Hysteroscopic use of coils in the tubal ostia (Essure) is a good option for above patients to avoid entry to abdominal cavity,because of

Extensive abdominal adhesions and multiple prior abdominal surgeries…

A hysterosalpingogram is recommended following the procedure to ensure that the tubes are occluded…