STERILIZATION TECHNIQUE BY LAPAROSCOPIA

Admission Criteria

•   Following the present norms of surgery without entrance, the patient to take part, it must fulfill conditions personal that can guarantee that a restricted discharge is feasible in their case. The conditions are:
• Legal age.
• Able legally (the disabled people legally must have a judicial permission).
• To be alphabet person.
• To go and to be accompanied following the 24 hours to the intervention, by an adult non diminished responsible and alphabet.
• It must be guaranteed that the patient will understand and assume his responsibility in post operating and will follow the instructions that are indicated to him.
• It must be guaranteed that in the place where he remains following the 24-48 hours there are no difficulties that jeopardize their security (environmental, hygienic conditions, to be evacuated facility if it is necessary, capacity of telephone communication with qualified medical or sanitary personnel and in case of doubts in the postoperating course: an suitable welfare center readily accessible that can take care of the complications, if one appears, etc).
• If the patient resides outside Valencia, must be contemplating to be leftin in this city, if outside necessary 24 hours. Is essential the presentation of the DNI or PASSPORT.

Selection Criteria

All not the applicants are tributary of being taken care of within the modality of surgery without entrance, according to present the medical and legal criteria. One is due to consider that:

• The patient does not have to present/display added extra pathology. In the tactical mission of the tubaric blockade, the anesthetic classification haven’t to exceed the qualification ASA I or ASA II.
• The patient does not have to present/display antecedents of pelvic, clinical or postsurgery disease inflammatory.
• The patient must not have laparotomics wounds in line mediates infraumbilical.
• The patient will not have to present/display great fatty in meso and hipogastric (between the navel and pubis), although the best thing is than she decides the own laparoscopist that must overcome the difficulty.

Preoperating Criteria

• The patient it must be reasonably safe of not being pregnant woman, has even though not needed the menstruation.
• Sign a request of intervetion and a copy of the information corresponding to the intervetion
• Will have to practice an preoperatoring examination or to contribute documentation written to it to have practiced, with a report that specifies: he does not present/display contraindication to be practiced exploration by laparoscopy. The preoperating exploration for a patient who does not suspect added extra pathology to him would be:
1. Anamnesis, clinical history and obstetrician-gynecological antecedents.
2. Analytical determinations in blood: hematocrit, hematies, leukocytes, hemoglobin, plaquets, rate of prothrombin, time of partial tromboplastin, group and Rh, extending it in those cases that are considered recommendable.
3. ECG to all the patient who exceeds the 35years, or suspect to alterations cardiocirculatories.
4. RX of thorax and profile to all patient who suspects respiratory pathology.
5. Psychosomatic consultation to guarantee that it is an assumed affluent decision, especially in women of less than 35 years and less than 2 Children.

Preparation to the intervention

• The patient must practice an intestinal preparation that is provided during the preoperating interview.
• The patient will have to be in uninformed of liquids and solids, as well as without smoking from 6 hours like minimum before the intervention.

Operating methodology

Practical the intervention under an anesthetic combination of very fast assimilation, without using muscular relax nor greater analgesic, reason why can be considered to the patient recovered between one hour and two after finishing the anesthetic act.

The boarding technique that is used is laparoscopic, entering the abdominal cavity by a periumbilicaly incision of a centimeter of length, after the creation of a pneumoperitone of approximately 3 liters of CO 2.

The used system to block the tubes of Fallopian tube, is the electrocoagulation with bipolar clamp.

The skin is closed with a point of silk of the 2/0, that is advisable to retire to the week,

The average time of intervention calculates between 10 and 20 minutes.

Restricted discharge Criteria

When the patient presents/displays, sensorial recovered, good space direction temporo, capacity for the bipedestation and deambulation and constants within normality, approximately 2 h. after finalizing the operation.

Observations

  The tubaric intervention of blockade can be silmutanely with the accomplishment of the caused abortion taking advantage of the same anesthetic time. If it is considered opportune and the aforesaid conditions meet.