Answer
Modified Pomeroy method
The fallopian tube is then followed back to the mid-isthmic portion, and a loop of tube is elevated with the Babcock clamp. The base of the loop is ligated with 2 ties of 2-0 plain gut suture, holding one suture long with a hemostat to avoid retraction of the tube back into the abdomen after transection (see the image below).
Ligating the fallopian tube in the mid-isthmic region using 2-0 plain gut suture.
Next, a window is created bluntly in the mesosalpinx within the loop using the tips of the Metzenbaum scissors (see the first image below). Each limb of the tube is then individually cut, leaving an adequate tubal stump proximally and distally to ensure that the cut ends do not slip through the suture (see the second image below).
Excising the tubal segment. Note that the tube is being held by a hemostat to avoid retraction into the abdomen after complete excision.
The tubal segment is routinely sent to surgical pathology for confirmation. While holding onto the hemostat, the cut ends are inspected for the presence of tubal ostia both proximately and distally as well as hemostasis (see the following image). Tension on the suture should be released when observing for hemostasis. The tube is then released back into the abdomen. This procedure is then repeated on the remaining side.
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Instruments for postpartum sterilization by minilaparotomy.
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Entering the abdomen.
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Using the Army-Navy retractors.
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Packing with a small laparotomy sponge.
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Elevation of the fallopian tube through the incision.
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Ligating the fallopian tube in the mid-isthmic region using 2-0 plain gut suture.
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Piercing the mesosalpinx with Metzenbaum scissors.
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Excising the tubal segment. Note that the tube is being held by a hemostat to avoid retraction into the abdomen after complete excision.
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Visualizing the cut ends of the fallopian tube.
