Laparoscopic sterilization in the supine position using the Ramathibodi uterine manipulator.

ABSTRACT

OBJECTIVES: To investigate the usefulness of the Ramathibodi uterine manipulator (AMZURA Enterprises, Freeport, NY) in performing laparoscopic sterilization procedures in the supine position under local anesthesia. DESIGN: Descriptive prospective study. SETTING: Ambulatory surgical unit of university-affiliated hospital. PATIENTS Women presenting for elective sterilization and weighing < 110 kg. INTERVENTION The Ramathibodi uterine manipulator was used to provide uterine manipulation in 85 cases of laparoscopic sterilization, all performed in the supine position as local anesthesia-sedation sterilization operations. Because such procedures are becoming more common worldwide, we propose the acronym "LASSO" (Local Anesthesia-Sedation Sterilization Operation) for this class of operations. Although commonly used in minilaparotomy procedures, use of this uterine manipulation device in laparoscopic procedures has not been published previously. MAIN OUTCOME MEASURE: Successful tubal occlusion. RESULTS: Among the 85 cases reported here there were no failures to manipulate the uterus successfully, to identify the tubes, and to occlude them. CONCLUSIONS: The simplicity of the Ramathibodi uterine manipulator provided several advantages over other means of uterine manipulation, notably [1] constant easy-to-learn maneuvers, [2] no tenaculum or balloon requirement, [3] the procedure could be performed in the supine position, and [4] there are no working parts, screws, or springs that could be lost or broken by operating room staff. Our experience with this device leads us to recommend it to colleagues as an inexpensive, safe, and effective alternative to currently available instruments for providing uterine elevation during laparoscopic sterilization procedures.

ABSTRACT

PIP The utility of the Ramathibodi uterine manipulator in performing laparoscopic sterilization procedures in the supine position under local anesthesia was explored in a descriptive prospective study of 85 women who presented to the Johns Hopkins Bayview Medical Center (Baltimore, Maryland, US) for elective outpatient sterilization. Although commonly used in minilaparotomy procedures, experience with this device in laparoscopic procedures has not been reported previously. In the Hopkins series, there were no failures to manipulate the uterus, identify the tubes, and occlude them. Among the advantages of this method are constant easy-to-learn maneuvers, lack of tenaculum or balloon requirements, capacity to perform the procedure in the supine position, and an absence of working parts, screws, or springs that could be lost or broken. Local anesthesia-sedation sterilization procedures are likely to become increasingly common in patient-oriented, cost-conscious health care environments. The acronym LASSO (Local Anesthesia-Sedation Sterilization Operation) is proposed for this class of operations.