Office Single Puncture Laparoscopy Sterilization with Local Anesthesia

BACKGROUND AND OBJECTIVES Recently there has been a renewed interest in office based laparoscopy sterilization utilizing local anesthesia with conscious intravenous sedation. The safety of performing the procedure outside of a hospital environment has been questioned. The author attempts to determine the incidence of major complications with a review of the literature and a retrospective chart review of his personal cases. METHODS During the period from 1971 to 1995, the author performed 1,753 laparoscopic procedures, utilizing local anesthesia in 1,562 cases and general anesthesia in the remainder. The focus of this chart study is the 1,190 laparoscopy sterilization cases performed in an office exam room setting, utilizing local anesthesia and conscious intravenous analgesia. Conventional 10 mm single puncture laparoscopy equipment was used. Major complications were defined as requiring laparotomy, blood transfusion, cardiopulmonary resuscitation, or emergency transfer to the hospital. RESULTS The author's series contained one major complication, which was easily handled in the office environment. A review of the literature, including the author's series, revealed a major complication incidence of 5 out of 20,568 cases reviewed. None of these five complications would have required immediate laparotomy or blood transfusion to prevent a fatality. CONCLUSION The author proposes that there is no documented evidence that office laparoscopy places the patient at increased risk for a life-threatening complication and should be considered by experienced gynecologic laparoscopists who are interested in cost containment.