Editing Tubal ligation (section)

==Tubal ligation methods==
There are a number of methods of removing or occluding the fallopian tubes, some of which rely on medical implants and devices.

=== Postpartum tubal ligation ===
Performed immediately after a delivery, this method removes a segment, or all, of both fallopian tubes. The most common techniques for partial bilateral salpingectomy are the [[Ralph Pomeroy (gynecologist)|Pomeroy]]<ref>{{cite web|url=http://www.atlasofpelvicsurgery.com/6FallopianTubesandOvaries/12SterilizationbythePomeroyOperation/chap6sec12.html|title=Sterilization by the Pomeroy Operation|publisher=Atlasofpelvicsurgery.com|access-date=2013-06-25}}</ref> or Parkland<ref>{{Cite web|url=http://www.glowm.com/section_view/heading/Surgical%20Procedures%20for%20Tubal%20Sterilization/item/399#33605|title=The Parkland Procedure|date=24 July 2019|website=The Global Library of Women's Medicine}}</ref> procedures. The ten year pregnancy rate is estimated at 7.5 pregnancies per 1000 procedures performed, and the ectopic pregnancy rate is estimated at 1.5 per 1000 procedures performed.<ref name=":02" />

=== Interval tubal ligation ===

==== Bilateral [[salpingectomy]] ====
This method removes both tubes entirely, from the uterine cornuae out to the tubal fimbriae. This method has recently become more popular for female sterilization, given evidence to support the fallopian tube as the potential site of origin of some ovarian cancers.<ref>{{Cite journal|last1=Powell|first1=C. Bethan|last2=Alabaster|first2=Amy|last3=Simmons|first3=Sarah|last4=Garcia|first4=Christine|last5=Martin|first5=Maria|last6=McBride-Allen|first6=Sally|last7=Littell|first7=Ramey D.|date=November 2017|title=Salpingectomy for Sterilization: Change in Practice in a Large Integrated Health Care System, 2011–2016|journal=Obstetrics & Gynecology|language=en|volume=130|issue=5|pages=961–967|doi=10.1097/AOG.0000000000002312|pmid=29016486|s2cid=45039217|issn=0029-7844|doi-access=free}}</ref> Some large medical systems such as Kaiser Permanente Northern California <ref>{{Cite web|url=https://download.lww.com/wolterskluwer_vitalstream_com/PermaLink/AOG/A/AOG_128_2_2016_06_02_GARCIA_16-200_SDC1.pdf|title=Practice Resource: Salpingectomy for Ovarian Cancer Prevention|date=May 2013|access-date=30 July 2019}}</ref> have endorsed complete bilateral salpingectomy as the preferred means of female sterilization and professional medical societies such as the Society of Gynecologic Oncology <ref>{{Cite web|url=https://www.sgo.org/clinical-practice/guidelines/sgo-clinical-practice-statement-salpingectomy-for-ovarian-cancer-prevention/|title=SGO Clinical Practice Statement: Salpingectomy for Ovarian Cancer Prevention|date=November 2013|website=Society of Gynecologic Oncology|access-date=30 July 2019}}</ref> and the American College of Obstetricians and Gynecologists (ACOG) recommend discussing the benefits of salpingectomy during counseling for sterilization.<ref>{{Cite journal|date=April 2019|title=ACOG Committee Opinion No. 774: Opportunistic Salpingectomy as a Strategy for Epithelial Ovarian Cancer Prevention|journal=Obstetrics and Gynecology|volume=133|issue=4|pages=e279–e284|doi=10.1097/AOG.0000000000003164|issn=1873-233X|pmid=30913199|doi-access=free}}</ref> While complete bilateral salpingectomy theoretically should have an efficacy rate that approaches 100 percent and eliminates the risk of tubal ectopic pregnancy, there is not high quality data available comparing this method to older methods.{{citation needed|date=May 2023}}

==== Bipolar coagulation ====
This method uses electric current to cauterize sections of the fallopian tube, with or without subsequent division of the tube.<ref name=":4">{{cite web|url=http://www.atlasofpelvicsurgery.com/6FallopianTubesandOvaries/9SterilizationbyElectrocoagulationandDivisionviaLaparoscopy/chap6sec9.html|title=Sterilization by Electrocoagulation and Division via Laparoscopy|publisher=Atlasofpelvicsurgery.com|access-date=2013-06-25}}</ref> The ten year pregnancy rate is estimated at 6.3 to 24.8 pregnancies per 1000 procedures performed, and the ectopic pregnancy rate is estimated at 17.1 per 1000 procedures performed.<ref name=":02" />

==== Monopolar coagulation ====
This method uses electric current to cauterize the tube, but also allows radiating current to further damage the tubes as it spreads from the coagulation site. The tubes may also be transected after cauterization.<ref name=":4" /> The ten year pregnancy rate is estimated at 7.5 pregnancies per 1000 procedures performed.<ref name=":02" />

==== Tubal clip ====
This method uses a tubal clip (Filshie clip or Hulka clip) to permanently clip the fallopian tubes shut. Once applied and fastened, the clip blocks movement of eggs from the ovary to the uterus.<ref>{{cite web|url=http://www.atlasofpelvicsurgery.com/6FallopianTubesandOvaries/11HulkaClipSterilizationviaLaparoscopy/chap6sec11.html|title=Hulka Clip Sterilization via Laparoscopy|publisher=Atlasofpelvicsurgery.com|access-date=2013-06-25}}</ref> The ten year pregnancy rate is estimated at 36.5 pregnancies per 1000 procedures performed, and the ectopic pregnancy rate is estimated at 8.5 per 1000 procedures performed.<ref name=":02" />

==== Tubal ring (Falope ring) ====
This method involves a doubling over of the fallopian tubes and application of a silastic band to the tube.<ref>{{cite web|url=http://www.atlasofpelvicsurgery.com/6FallopianTubesandOvaries/10SilasticBandSterilizationviaLaparoscopy/chap6sec10.html|title=Silastic Band Sterilization via Laparoscopy|publisher=Atlasofpelvicsurgery.com|access-date=2013-06-25}}</ref> The ten year pregnancy rate is estimated at 17.7 pregnancies per 1000 procedures performed, and the ectopic pregnancy rate is estimated at 8.5 per 1000 procedures performed.<ref name=":02" />

=== Less commonly used or no longer used procedures ===

==== Irving's procedure ====
This method places two ligatures (sutures) around the fallopian tube and removing the segment of tube between the ligatures. The medial ends of the fallopian tubes on the side closer to the uterus are then connected to the back of the uterus itself.<ref>{{cite web|url=http://www.atlasofpelvicsurgery.com/6FallopianTubesandOvaries/13SterilizationbytheModifiedIrvingTechnique/chap6sec13.html|title=Sterilization by the Modified Irving Technique|publisher=Atlasofpelvicsurgery.com|access-date=2013-06-25}}</ref>

==== Uchida tubal ligation ====
This method involves dissecting the fallopian tube from the overlying connective tissue (serosa), placing two ligatures and excising a segment of the tube, then buries the end of the fallopian tube closest to the uterus underneath the serosa.<ref>{{Cite web|last=Sciarra|first=John J.|title=Volume 6, Chapter 39. Surgical Procedures for Tubal Sterilization|url=https://www.glowm.com/resources/glowm/cd/pages/v6/v6c039.html#theu|access-date=31 August 2020|website=www.glowm.com}}</ref> Dr. Uchida reported no failures among 20,000 procedures.<ref>{{Cite journal|last1=Green|first1=L. R.|last2=Laros|first2=R. K.|date=June 1980|title=Postpartum sterilization|url=https://www.ncbi.nlm.nih.gov/pubmed/6447003|journal=Clinical Obstetrics and Gynecology|volume=23|issue=2|pages=647–659|doi=10.1097/00003081-198006000-00030|issn=0009-9201|pmid=6447003}}</ref><ref>{{Cite journal|last=Uchida|first=H.|date=1975-01-15|title=Uchida tubal sterilization|url=https://www.ncbi.nlm.nih.gov/pubmed/123119|journal=American Journal of Obstetrics and Gynecology|volume=121|issue=2|pages=153–158|doi=10.1016/0002-9378(75)90630-4|issn=0002-9378|pmid=123119}}</ref>

==== Essure tubal ligation====
This method closed the fallopian tubes through a [[Hysteroscopy|hysteroscopic]] approach by placing two small metal and fiber coils in the fallopian tubes through the fallopian ostia. After insertion, scar tissue forms around the coils, blocking off the fallopian tubes and preventing sperm from reaching the egg.<ref>{{cite web|url=https://www.fda.gov/medicaldevices/productsandmedicalprocedures/deviceapprovalsandclearances/recently-approveddevices/ucm083087.htm|title=Essure™ System - P020014|publisher=Fda.gov|access-date=2013-06-25}}</ref> It was removed from the US market in 2019.<ref name=":0" />

==== Adiana tubal ligation ====
This method closed the fallopian tubes through a [[Hysteroscopy|hysteroscopic]] approach by placing two small silicone pieces in the fallopian tubes. During the procedure, the health care provider heated a small portion of each fallopian tube and then inserts a tiny piece of silicone into each tube. After the procedure, scar tissue formed around the silicone inserts, blocking off the fallopian tubes and preventing sperm from reaching the egg.<ref>{{cite press release|url=http://globenewswire.com/news-release/2012/04/30/474765/253823/en/Conceptus-R-Announces-Settlement-of-Patent-Infringement-Lawsuit-With-Hologic.html|title=Conceptus(R) Announces Settlement of Patent Infringement Lawsuit With Hologic Nasdaq:CPTS|date=30 April 2012|publisher=Globenewswire.com|access-date=25 June 2013}}</ref> It was removed from the US market in 2012.