title: Minilaparotomy and endoscopic techniques for tubal sterilisation.
abstract: OBJECTIVE
  To evaluate laparoscopic tubal sterilisation, as compared to minilaparotomy in terms of operative morbidity and mortality. Trials comparing laparoscopy or minilaparotomy with culdoscopy were also included in the review. Different methods used to interrupt tubal patency (excision, occlusion and coagulation) and comparison of different forms of anaesthesia will be considered in different reviews.
  
  
  METHODS
  Randomised controlled trials (RCTs) have been identified by using the search strategy of the Cochrane Collaboration. The Cochrane Controlled Trials Register has been searched. Reference lists of identified trials have been searched.
  
  
  METHODS
  All randomised controlled trials comparing laparoscopy, minilaparotomy and/or culdoscopy for tubal sterilisation. Except in one trial [Taner 1994] where 4 women underwent curettage at the same time, all women requested tubal sterilisation as an interval procedure.
  
  
  METHODS
  Trials under consideration were evaluated for methodological quality and appropriateness for inclusion. Data were extracted independently by the reviewers. Results are reported as odds ratio for dichotomous outcomes and weighted mean differences for continuous outcomes.
  
  
  RESULTS
  Minilaparotomy vs laparoscopy: There was no difference in major morbidity between the 2 groups. Minor morbidity was significantly less in the laparoscopy group (Peto OR 1.89; 95% CI 1.38, 2.59). Duration of operation was about 5 minutes shorter in the laparoscopy group (WMD 5.34; 95% CI 4. 52, 6.16). Minilaparotomy vs culdoscopy: Women undergoing culdoscopy had more major morbidity than women for whom minilaparotomy was performed (Peto OR 0.14; 95% CI 0.02, 0.98). Duration of operation was about 5 minutes shorter in women undergoing culdoscopy (WMD 4. 91; 95% CI 3.82, 6.01). Laparoscopy vs culdoscopy: In the one trial comparing the two interventions there were no significant differences between the groups with regard to major morbidity. Significantly more women suffered from minor morbidities in the culdoscopy group compared to the laparoscopy group (Peto OR 0.20; 95% CI 0.05, 0.77).
  
  
  CONCLUSIONS
  Major morbidity seems to be a rare outcome for both, laparoscopy and minilaparotomy. The included studies had limited power to demonstrate significant differences especially for the relatively rare but potentially serious outcomes. Personal preference of the woman and/or of the surgeon can guide the choice of technique. Practical aspects (e.g. cost, maintenance, and sterilisation of the instruments) must be taken into account before implementing the more sophisticated endoscopic techniques in settings with limited resources. Culdoscopy is not recommended as it carries a higher complication rate.
authors.affiliation: WHO Collaborating Centre, University Hospital Geneva, Department of Obstetrics and Gynaecology, Boulevard de la Cluse, 32, Geneve, Switzerland, CH-1205. rkulier@hotmail.com
authors.forename: R
authors.initials: R
authors.lastname: Kulier
authors.forename: M
authors.initials: M
authors.lastname: Boulvain
authors.forename: D
authors.initials: D
authors.lastname: Walker
authors.forename: G
authors.initials: G
authors.lastname: de Candolle
authors.forename: A
authors.initials: A
authors.lastname: Campana
mesh_terms: D005260:Female; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D013246:Sterilization, Tubal / Q000379:methods*