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Laparoscopic female sterilization

Kari P Braaten, MD, MPH
Caryn Dutton, MD, MS
Section Editors
Tommaso Falcone, MD, FRCSC, FACOG
Jody Steinauer, MD, MAS
Deputy Editor
Sandy J Falk, MD, FACOG


Female sterilization (also referred to as tubal ligation) includes a number of different procedures and techniques that provide permanent contraception for women. The most common techniques prevent pregnancy by disrupting the patency of the fallopian tubes [1]. This prevents conception by blocking transport of sperm from the lower genital tract to an ovulated oocyte.

Female sterilization may be performed immediately after childbirth (postpartum sterilization) or at a time unrelated to a pregnancy (interval sterilization). Most postpartum sterilization procedures are performed at time of cesarean delivery or after a vaginal delivery via mini-laparotomy. Most interval sterilization procedures are performed via laparoscopy.

This topic review will focus on female laparoscopic sterilization. An overview of general principles of female sterilization as well as postpartum sterilization and hysteroscopic sterilization are discussed separately. (See "Overview of female sterilization" and "Postpartum sterilization" and "Hysteroscopic sterilization".)


The only indication for sterilization is the patient's desire for permanent contraception. Ultimately, the choice is made by the patient, but the decision requires thorough counseling about permanent sterility and the risk of regret.

There are no medical conditions that are strictly incompatible with laparoscopic sterilization; however, there may be factors that make women more suitable for a particular route of sterilization or other contraceptive options. (See "Overview of female sterilization", section on 'Assessing surgical risk'.)

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Literature review current through: Nov 2017. | This topic last updated: Mar 19, 2017.
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  1. Moss C, Isley MM. Sterilization: A Review and Update. Obstet Gynecol Clin North Am 2015; 42:713.
  2. Peterson HB. Sterilization. Obstet Gynecol 2008; 111:189.
  3. Oskowitz S, Haverkamp AD, Freedman WL. Experience in a series of fimbriectomies. Fertil Steril 1980; 34:320.
  4. Penfield AJ. The Filshie clip for female sterilization: a review of world experience. Am J Obstet Gynecol 2000; 182:485.
  5. Peterson HB, Xia Z, Hughes JM, et al. The risk of pregnancy after tubal sterilization: Findings from the U.S. Collaborative Review of Sterilization. Am J Obstet Gynecol 1996; 174:1161.
  6. Peterson HB, Xia Z, Wilcox LS, et al. Pregnancy after tubal sterilization with bipolar electrocoagulation. U.S. Collaborative Review of Sterilization Working Group. Obstet Gynecol 1999; 94:163.
  7. Soderstrom RM, Levy BS, Engel T. Reducing bipolar sterilization failures. Obstet Gynecol 1989; 74:60.
  8. http://www.richardwolfusa.com/fileadmin/images/content/USA_data/PDF_documents/Gynecology/Bipolar_Forceps_GB.pdf (Accessed on December 21, 2015).
  9. Peterson HB, Ory HW, Greenspan JR, Tyler CW Jr. Deaths associated with laparoscopic sterilization by unipolar electrocoagulating devices, 1978 and 1979. Am J Obstet Gynecol 1981; 139:141.
  10. Pakter J, Budnick LD. Bladder perforation owing to a unipolar coagulating device. Am J Obstet Gynecol 1981; 141:227.
  11. Peterson HB, DeStefano F, Rubin GL, et al. Deaths attributable to tubal sterilization in the United States, 1977 to 1981. Am J Obstet Gynecol 1983; 146:131.
  12. Yoon I, King TM. The laparoscopic falope ring technique. Adv Plan Parent 1975; 10:154.
  13. Dominik R, Gates D, Sokal D, et al. Two randomized controlled trials comparing the Hulka and Filshie Clips for tubal sterilization. Contraception 2000; 62:169.
  14. Subair O, Uku A, Amu O. Hydrosalpinx complicating routine double clip sterilisation. J Obstet Gynaecol 2004; 24:942.
  15. Rock JA, Jones HWI. Te Linde's Operative Gynecology, 10th ed, Lippencott, Williams & Wilkins, Philadelphia 2008.
  16. Lundstrom P, Technical Support Representative, Richard Wolf Medical Instruments Corp, Vernon Hills, IL, October 29, 2015, personal communication.
  17. McAlpine JN, Hanley GE, Woo MM, et al. Opportunistic salpingectomy: uptake, risks, and complications of a regional initiative for ovarian cancer prevention. Am J Obstet Gynecol 2014; 210:471.e1.
  18. Westberg J, Scott F, Creinin MD. Safety outcomes of female sterilization by salpingectomy and tubal occlusion. Contraception 2017.
  19. Creinin MD, Zite N. Female tubal sterilization: the time has come to routinely consider removal. Obstet Gynecol 2014; 124:596.
  20. Jamieson DJ, Hillis SD, Duerr A, et al. Complications of interval laparoscopic tubal sterilization: findings from the United States Collaborative Review of Sterilization. Obstet Gynecol 2000; 96:997.
  21. Mao J, Pfeifer S, Schlegel P, Sedrakyan A. Safety and efficacy of hysteroscopic sterilization compared with laparoscopic sterilization: an observational cohort study. BMJ 2015; 351:h5162.
  22. Lawrie TA, Kulier R, Nardin JM. Techniques for the interruption of tubal patency for female sterilisation. Cochrane Database Syst Rev 2016; :CD003034.
  23. Sokal D, Gates D, Amatya R, Dominik R. Two randomized controlled trials comparing the tubal ring and filshie clip for tubal sterilization. Fertil Steril 2000; 74:525.
  24. Coll AM, Ameen J. Profiles of pain after day surgery: patients' experiences of three different operation types. J Adv Nurs 2006; 53:178.
  25. Lawrie TA, Kulier R, Nardin JM. Techniques for the interruption of tubal patency for female sterilisation. Cochrane Database Syst Rev 2015; :CD003034.
  26. Pymar HC, Creinin MD, Vallejo MC. Prospective randomized, controlled study of postoperative pain after titanium silicone rubber clip or Silastic ring tubal occlusion. Contraception 2004; 69:145.
  27. Geirsson RT, Currie J, Redpath A. Prospective comparison of postoperative morbidity after laparoscopic sterilization with rings and clips. British Journal of Family Planning 1985; 11:55.
  28. Brennan MC, Ogburn T, Hernandez CJ, Qualls C. Effect of topical bupivacaine on postoperative pain after laparoscopic tubal sterilization with Filshie clips. Am J Obstet Gynecol 2004; 190:1411.
  29. Kaplan P, Freund R, Squires J, Herz M. Control of immediate postoperative pain with topical bupivacaine hydrochloride for laparoscopic Falope ring tubal ligation. Obstet Gynecol 1990; 76:798.
  30. Peterson HB, Xia Z, Hughes JM, et al. The risk of ectopic pregnancy after tubal sterilization. U.S. Collaborative Review of Sterilization Working Group. N Engl J Med 1997; 336:762.
  31. Malacova E, Kemp A, Hart R, et al. Long-term risk of ectopic pregnancy varies by method of tubal sterilization: a whole-population study. Fertil Steril 2014; 101:728.
  32. Varma R, Gupta JK. Failed sterilisation: evidence-based review and medico-legal ramifications. BJOG 2004; 111:1322.
  33. Koetsawang S, Srisupandit S, Cole LP. Laparoscopic electrocoagulation and tubal ring techniques for sterilization: a comparative study. Int J Gynaecol Obstet 1978; 15:455.
  34. Trussell J, Guilbert E, Hedley A. Sterilization failure, sterilization reversal, and pregnancy after sterilization reversal in Quebec. Obstet Gynecol 2003; 101:677.
  35. Peterson HB, Pollack AE, Warshaw JS. Tubal Sterilization. In: Te Linde's Operative Gynecology, Rock JA, Jones HW (Eds), Lippincott Williams & Wilkins, Philadelphia 2008. p.609.
  36. Soderstrom RM. Sterilization failures and their causes. Am J Obstet Gynecol 1985; 152:395.