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복강경 난관불임수술에 관한 임상적 연구

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 Clinical study on laparoscopic tubal sterilization 
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Laparoscopic Tubal Sterilization has been popularized in recent days in accordance with increased demand of world wide Population Control Campain. However, it still has some problems to be improved, especially in tubal sterilization procedure. Most beloved technique for a long time is Electric Coagulation method,

but it has danger of heat injury such as bowel, bladder, or abdomenal wall burn.

Though Clip Application technique has developed as a cold method to devoid such major complications, it has not been proved to be satisfactory method in a view-point of operative failure.

One of the cold method, Silastic Band technique deviced by Dr. Yoon in Johns Hopkins University, is a tubal sterilization procedure similar to classic tubal ligation by means of Silastic Band application on tubes.

The purpose of this study is to compare the Silastic Band technique with classic electric coagulation method for evaluation of better tubal sterilization technique.

In this study, total 721 cases of Laparoscopic Tubal Sterilization were performed as the out patient bases at Yonsei University Hospital from April-1 1973 to Oct.-18 1974. among them, 427 cases were performed using Electric Coagulation method, and 294 cases using Silastic Band technique by random selection.

The obtaining results were as followings:

1. One hole laparoscope technique was used in all cases under local anesthesia with analgesics as a routine.

2. Mean operation time was 16.0 minutes, and there was no significant difference between Electric Coagulation group (mean 16.7 min) and Silastic Band group (mean 14.9 min.).

3. Average age of the clients was 34.3 years, and average number of living children was 3.4.

4. Incidental pregnancy termination in the first trimaster was performed in 110 cases by Menstrual Regulation or D & E followed by Laparocsopic sterilization without any increase in morbidity or operation time compared with non-pregnant group.

5. There was no major complication in Silastic Band group whereas 2 serious complications requiring laparotomy occured in Electric Coagulation group, one case was complicated from intestinal burn and the other was from uncontrolable bleeding from mesosalpinx.

6. 8 cases (1.9%) of bleeding from tubes or mesosalpinx were occured in Electric Coagulation group, while only one case of such complication occured in Silastic Band group. These complications of both groups were easily controlled by

re-coagulation of bleeding area.

7. Procedures of Electric Coagulation were failed in 4 cases out of 427 due to peritubal adhesion, but tubal sterilization was completed in 3 out of 4 cases by following Silastic Band Application. Overall failures to perform tubal sterilization procedure were only 2 cases (0.3%).

8. No operative failure was found in both groups at present. (about 1 year follow up.)

9. In this preliminary study form limited experience, Silastic Band technique can be thought as a safer procedure than Electric Coagulation technique.
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