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Query: UMLS:C0028754 (obesity)
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This is a report of a pilot program for laparoscopic sterilization with emphasis on surgical and anesthetic technics. In 1971 the program was developed at the North Carolina Memorial Hospital. Subjects were 129 private patients, mostly white, of middle income with 2 or more children, and from 19 to 47 years of age. Follow up of over 90% indicated high patient satisfaction. Complications were few but may occasionally require surgical management and the method should not be considered a minor procedure. At first patients were handled as inpatients for 1 day preceding surgery. Later an outpatient status was adopted. At an earlier visit a history is taken, instructions given by a nurse, the assigned physician (who may be a physician in training) reviews the history, performs a physical examination, and explains the operation to both the patient and her husband. Laboratory work is performed, operative permits are signed, and patients are asked at this time to agree to sterilization by laparotomy if the laparoscopic approach proves infeasible. On the morning of surgery suitable intravenous medication (Valium 5 mg), fentanyl, and atropine are given and followed by pure oxygen inhalation for 3-5 minutes. Pentothal followed by succinylcholine are given and the patient intubated. Anesthesia is maintained by succinylcholine drip and inhalation of nitrous oxide and oxygen. After surgical preparation with Betadine solution, a combination tenaculum-sound is placed in the cervical canal. Pneumoperitoneum is established with carbon dioxide gas through a Verres needle inserted through a small subumbilical incision. The laparoscopic trocar is introduced by enlarging the same incision. After inspection a second 6 mm trocar is inserted just about the tubes and biopsy forceps introduced. The tenaculum in the cervix is used to position the uterus and tubes. After cauterization tubes are divided with the biopsy forceps and a biopsy specimen obtained if possible without undue action on the tube. After inspection for bleeding or injury to other viscera, the instruments are withdrawn. The procedure can be completed in 15 minutes. After recovery from the anesthesia the patient is removed to the recovery area and then the holding area. After 2 or 3 hours she is seen by a physician and discharged if vital signs are stable. Oral and written instructions for her convalescence are given. Patients are requested to return in 2 weeks or to consult a physician in their home area. 30 patients required postoperative hospital admissions: 15 for non-medical reasons (i.e., distance to travel home) and 15 for observation at the physicians' request. These stayed 14 to 24 hours. Nausea and vomiting were indications in 5. :In one case nosebleed following intubation combined with slight elevation of temperature caused a stay of 48 hours. Retrospectively, only 8 of the 15 hospitalized or 6% of all cases required this extra service. In the initial series there was 1 technical failure due to obesity. The average time to resume normal activities was 3 1/2 days. 115 patients (97.4%) of those responding to a questionnaire stated they would recommend the procedure to a friend. The 3 dissatisfied respondents gave no specific reason. Thorough training of the physicians is urged. Use as an office procedure with local anesthesia is not recommended. Single-puncture technic is being tried. Subsequently over 100 additional procedures have been performed.
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PMID:An outpatient program for laparoscopic sterilization. 426 75