A post-partum minilaparotomy bilateral tubal ligation provides a surgical method for permanently sterilizing a woman by cutting and tying the fallopian tubes. This procedure represents the most popular choice of permanent contraception for women over the age of 35, with 325,000 procedures performed annually [1]. The first step in the surgery involves making a one inch incision immediately below the naval. After performing a blunt dissection to break through the peritoneum, the surgeon uses a pair of Army/Navy retractors to visualize the fallopian tubes. One retractor holds the incision open while he uses the other to fish for and find the back of the uterus. Once the surgeon feels the uterine wall on the back of his retractor, he gently moves outward along the fallopian tube before lifting it up towards the incision. Because of the viscoelastic properties of the tubes and the lack of a groove on the retractor head, this process may take time, especially with an obese patient [2].
The surgeon has a variety of methods to ligate the fallopian tube, but he must visualize and isolate it in the same manner for every procedure. Because of the number of these procedures annually and the consistency with which each one is performed, one of the design goals was to create a device that would mimic the actions a surgeon would take with an Army/Navy retractor as closely as possible. As a result, the final instrument will be specifically used for postpartum minilaparotomy bilateral tubal ligations.
Need
While a post-partum tubal ligation is normally a relatively simple procedure, it becomes greatly more difficult when the patient is morbidly obese. Locating and visualizing the fallopian tubes through thick layers of fat is difficult because the incision is vastly deeper (10-15cm) than it is wide (2-3cm). As a result, the surgeon must work in a much tighter space with limited visibility and decreased dexterity. Also, thick layers of fat compress the patient’s internal organs, making it hard to maneuver around the uterus and isolate the fallopian tubes without damaging the surrounding tissues. In such difficult cases, it may take the surgeon up to ninety minutes to extract the fallopian tubes. In the worst scenarios, a morbidly obese patient could require a much larger incision, generally making the surgery more invasive. The patient must remain under anesthesia for longer periods of time, elevating the risk of surgical complications [3].
The surgeon has a variety of methods to ligate the fallopian tube, but he must visualize and isolate it in the same manner for every procedure. Because of the number of these procedures annually and the consistency with which each one is performed, one of the design goals was to create a device that would mimic the actions a surgeon would take with an Army/Navy retractor as closely as possible. As a result, the final instrument will be specifically used for postpartum minilaparotomy bilateral tubal ligations.
Need
While a post-partum tubal ligation is normally a relatively simple procedure, it becomes greatly more difficult when the patient is morbidly obese. Locating and visualizing the fallopian tubes through thick layers of fat is difficult because the incision is vastly deeper (10-15cm) than it is wide (2-3cm). As a result, the surgeon must work in a much tighter space with limited visibility and decreased dexterity. Also, thick layers of fat compress the patient’s internal organs, making it hard to maneuver around the uterus and isolate the fallopian tubes without damaging the surrounding tissues. In such difficult cases, it may take the surgeon up to ninety minutes to extract the fallopian tubes. In the worst scenarios, a morbidly obese patient could require a much larger incision, generally making the surgery more invasive. The patient must remain under anesthesia for longer periods of time, elevating the risk of surgical complications [3].