In order to perform a tubal ligation operation, the abdomen is distended with carbon dioxide gas through a large needle, and the patient is put in a somewhat head down position so that the intestines will move out of the pelvis.
Once the abdomen is inflated, a small incision is made wherein the trocar, a large spike-like device that is hollow, within which the laparoscope will pass, is inserted. Care is taken not to perforate the intestines, particularly if there was a lower abdominal incision in which the intestines can get stuck to the inside of that abdominal scar.
Each fallopian tube, the size of a thin pink straw which is extending like arms off of each side of the body of the pear shaped uterus, is identified. It is grass with a forceps device that is attached to the electrocautery machine, and a burn is created. In the alternative, the tube can be clipped with a metal clip that secures it’s obstruction so no egg can pass down for fertilization.
In performing this operation, it is critical that at all stages the intestines are protected. Before the electrocautery device is turned on, it is essential that the intestines are not touching the tip of the electrocautery forceps. Likewise, when the punctures or created into the abdominal cavity, care is taken to be sure there is no injury to the intestines. As soon as the laparoscope is inserted, the gynecologist must check and see that there has been no damage to the intestines which can result in a perforation, and peritonitis from leakage, which if not timely recognized, could be deadly.