Sterilization | Medical Science Optional Notes for UPSC PDF Download

Male Sterilization 

NO SCALPEL VASECTOMY

This method of vasectomy 'without the use of a scalpel' was introduced in China in 1974 by Dr.Li Shungiangin Sichuan province, & has been used in other countries since 1986.

It required 2 instruments especially designed by Dr.Li.

• The extracutaneous ring forceps, a type of clamp which when closed makes a 34 mm ring shaped area at the top so as to hold vas extracutaneously & directly without injuring.
• Second instrument is the dissecting forceps which is similar to a curved mosquito forceps with sharply pointed tip. It is used to puncture the scrotal skin, spread the tissues, dissect the sheath & to deliver the vas.

PROCEDURE (3 finger technique)

• Using the 3 finger technique, both vas are identified at the junction of middle & upper 3rd of scrotum.
• The needle is advanced parallel to the vas within the external spermatic fascial sheath towards the inguinal ring, & local anaesthesia given.
• Vasectomy is done through a small puncture made over the vas.

A singular incision is created using a specialized forceps, eliminating the need for a skin stitch. This method can be executed at twice the speed of a typical vasectomy and entails only one-eighth of the complications associated with the standard vasectomy procedure.

Female Sterilization

Female sterilization is a permanent method, primarily involving the occlusion of the fallopian tubes.

Timing of Operation

• During Puerperium: The procedure can be performed 24-48 hours after delivery if the patient is otherwise healthy, offering technical simplicity.
• Interval: Conducted beyond 3 months post-delivery or abortion, ideally after the menstrual period in the proliferative phase.
• Concurrent with MTP: Sterilization performed simultaneously with the termination of pregnancy.
• Postpartum Sterilization: Done within the first week of delivery when the patient is already hospitalized.

Methods of Sterilization

• Laparotomy / Mini Laparotomy:
  • Laparotomy involves an incision over 5 cm and is often done during a cesarean section.
  • Mini Laparotomy uses a small suprapubic incision.
• Vaginal Tube Ligation:
  • Associated with high morbidity and mortality due to infection.
  • Challenging to perform with a higher failure rate.
• Laparoscopy:
  • Advantages include a small, nearly invisible subumbilical scar and outpatient department applicability.
  • Highly reversible with a success rate of 70% or more.
  • Disadvantages include expensive equipment, the need for experienced personnel, and low mortality rates.
• Hysteroscopy - 'Essure Permanent Device':
  • Involves a dynamically expanding micro-inserter with inner and outer coils made of stainless steel and nickel titanium alloy.
  • Advantages include no abdominal scar and the possibility of being performed under local anesthesia.
  • Disadvantages encompass the need for expertise, cost, a waiting period of 3 months, difficulty in bilateral insertion in 15% cases, impossibility of tuboplasty for reversal, and the risk of tube perforation.