Family Planning:

Surgical Methods
Ashli, Clarissa, Jen, Sayuri
Nurs 320 2/12/14

Surgical Methods
Tubal Ligation: female- abdominal surgery
tying your tubes
Vasectomy: male- quick snip

Tubal Ligation

Tubal Ligation

tubal occlusion methods

-ligation (tying)
-cauterization ( to cut &
burn closed)
-application of bands or
clips (blocking)

transabdominal procedure
***NEED consent form***
mini-laparotomy = most commonly used after vaginal birth (C/S)
-NPO after midnight before the procedure
-local, regional, general anesthetic
-provider makes a small incision in the abdominal wall below the umbilicus

laparoscopic= outpatient basis

-NPO after midnight before the procedure
-local, regional, general anesthetic
-two small incisions are made--a small one under the umbilicus for the laparoscope and one
above the symphysis pubis to occlude or ligate the tubes. the abdominal cavity is inflated with
air or a harmless gas so that the surgeon can see and avoid injuring abdominal organs.

-during procedure may experience sensation of

tugging but no pain
-outpatient=discharged several hours later

laparoscopic technique

advantages
-permanent contraception
-sexual function is unaffected-can return to sexual activities when feel
comfortable, usually within 4-7 days
-tubal ligation can be done right after you have a baby or during a
cesarean section
-takes about 30 min
-safe and highly effective
-most pts can resume all their normal activities after two to five
days

effective:
-99% effective

Disadvantages

-Tubal Ligation is an abdominal operation

-Does not protect from STI
-Considered irreversible in the event that a
client desires conception
-The younger the woman, the more likely the
sterilization is to fail

Risks/Side Effects
-Risks may include damage to: bowel, bladder, or
major blood vessels
-adverse reaction to anesthesia
-improper wound healing; infections
-higher risk with h/o pelvic/abdominal surgery, PID,
obesity, or DM
-If a woman does conceive after a tubal ligation, there
is a high chance the pregnancy will be ECTOPIC

contraindication:

pt does not fully understand the

intended permanence of the procedure
gynecologic malignancy
infection
pregnancy

Cost $1500-6000
Tubal Ligation is more expensive than a
vasectomy.....
Since July 1, 2012, HMSA plans that include Affordable Care Act (ACA) womens preventive services have offered
enhanced birth-control-related benefits for women. These include FDA-approved contraceptives, sterilization
procedures, and patient education and counseling.
If covered, the following contraceptives and contraceptive services are available to you at no charge (no copayment,
deductible, or coinsurance) when prescribed and rendered by an HMSA participating provider.

Sterilization procedure (tubal ligation).

Reversal?
It is possible, but requires major
(elective) surgery and is not always
effective
Insurance does not cover, upwards to
several thousand dollars plus hospital
costs
-tubal reconstruction is costly, difficult,

videos on tubal ligation

https://www.youtube.com/watch?v=GxRJ
H2f--P0

Vasectomy

Vasectomy

1.
2.

VASECTOMY

Vas deferens is
removed through a
small incision.

Two ends are clamped,

then divided.

Vasectomy Methods
1. Incision Method
2. No Scalpel Method
Created in China.
No scarring, but doctors should be specially trained in this method.

3. Vasclip Implant Procedure

Clip will clamp close vas deferens. Not as effective as other
procedures.

Vasectomy
Advantages
Safe
Effective (99.9%)
Permanent
No effect on hormones
or sex organs

Disadvantages

Irreversible
Not immediately effective
No protection against
STDs.

Risk/Side Effects:
Infection
fever >100F
blood or pus oozing from incision
excessive pain or swelling
Sperm granuloma
Congestive epididymitis
Recanalization

Cost $300-$5,000
Cheapest: Planned Parenthood, sliding scale

Expensive: Private doctors using No Scalpel method

HMSA PPO:
90% coverage In Network
70% coverage Out of Network
Kaiser Permanente: 90% coverage + $30/office visit

Reversal?
Vasovasostomy
reconnects the vas deferens
not covered by insurance

Other Methods?
Hysterectomy: total removal of the uterus, may
sometimes include removal of the ovaries and fallopian
tubes

Nursing Process
Who is this most appropriate for?
Tubal ligation is recommended for women
who have already had children and who
may be already undergoing a surgery such
as a C-section
-

Nursing Process
Vasectomy is also recommended over
tubal ligation for families who do not
want anymore children as it is cheaper,
less invasive with lower risks and side
effects

Nursing Process
- Relationship dynamics
- Spousal support
- Family structures
- Adequate knowledge
- Patient Education

Cultural Considerations
- Vasectomy vs Tubal Ligation in U.S?
- More popular method of contraception
among Korean & Japanese women is tubal
ligation.
- Hawaii - surgical methods discussed
mostly for married couples with multiple
children.

Spiritual Considerations
- Roman Catholic religion maintains its long standing
position against voluntary sterilization
- Opposition to the use of sterilization has also been
observed in Muslim groups

Video on Vasectomy
http://www.yourdailymedia.com/post/family-guy-peter-needs-a-vasectomy/

http://www.downvids.net/family-guy-what-is-a-vasectomy-193932.html

http://www.spike.com/video-clips/s726fp/vasectomy-quartet

http://www.pinkbike.com/video/32445/

References:
ATI nursing education. (2012). RN Maternal Newborn Nursing (8th ed). ???

Lowdermilk, D. & Perry S. (2013). Maternity & Womens Health Care (8th ed.). St. Louis: Mosby.

Mayo Clinic (2013). http://www.mayoclinic.org/tests-procedures/tubal-ligation-reversal/basics/definition/prc-20020246

Medline Plus (2013). Vasectomy. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/002995.htm

Medline Plus (2013). Tubal Ligation. Retrived form http://www.nlm.nih.gov/medlineplus/ency/article/002913.htm