Untying Tied Tubes: Monopolar Electrocoagulation
History of Tubal Sterilization
The first tubal sterilization method was tubal ligation and resection, reported in 1881! Ligation and resection- or ‘tying tubes’ was the most common surgery for sterilization until the advent of laparoscopic surgery in the mid 1900’s. As laparoscopic surgery became more popular, electrocoagulation (electrical burning) of the fallopian tubes became a popular method of female sterilization.
Tubal Electrocoagulation Results in Burned Tubes
The first description of laparoscopic electrocoagulation, in 1962, used a type of electrical current termed monopolar current – hence the term monopolar tubal coagulation. This sterilization procedure uses electric current to destroy part of the fallopian tube. The burned part of the tube turns into scar tissue and the remaining tubal segments are separated and blocked. This was a very popular form of laparoscopic sterilization from 1970 until the early 1980’s.
Although monopolar electrocautery is a very effective form of tubal sterilization, studies showed that it had a higher complication rate than for electrocoagulation using bipolar current, where the damage to the fallopian tube (or other structures) is more easily restricted. Sterilization procedures done by monopolar current are gradually decreasing and being replaced with bipolar current. Monopolar cautery, however, is still used for tubal sterilization by some doctors.
Can Burned Tubes Be Repaired?
Patients often ask whether burned tubes can be repaired. In most cases, monopolar electrocoagulation sterilization procedures can be reversed. The success of reversal is dependent on the amount of fallopian tube that has been damaged by the electrocautery. This information is usually available in the tubal ligation operative report. When in doubt, a screening laparoscopy can be performed. Approximately 50% of patients at Chapel Hill Tubal Reversal Center will become pregnant after a reversal of a monopolar coagulation sterilization procedure.
Many people, including doctors, have been told that tubal sterilization is permanent and irreversible. Although monopolar tubal coagulation is intended to be permanent, this procedure is usually revesible. The best place for women to have their tubes ‘untied’ when they have been burned is Chapel Hill Tubal Reversal Center – the only medical facility that specializes in reversal of tubal ligation.
Submitted by Dr. Charles Monteith
August 12th, 2008 at 11:08 am
It’s reassuring to patients who have had a tubal ligation that tubal reversal is possible in 98% of the cases Dr. Berger and Dr. Monteith see. Women who are considering tubal ligation for sterilization can learn from our website that certain tubal ligation procedures are less traumatic to the fallopian tube than others. This is valuable information if there is any chance for reversal at a later date.
May 19th, 2008 at 11:32 am
Fortunately for the women who have had monopolar coagulation as a means of tying the tubes Dr. Monteith and Dr. Berger are able to offer encouragement through tubal reversal surgery.
May 19th, 2008 at 7:50 am
Thank you for another informative blog topic Dr. Monteith. Luckily, the monopolar coagulation method was rarely used. In recent years it is almost never used. When bipolar cautery came into use in the early 1980s doctors started using this instead as it is safer to use as it does less damage to tissue.
May 19th, 2008 at 6:59 am
Thanks Dr Monteith, another great blog on the many types of tubal ligation.
May 19th, 2008 at 6:15 am
The screening laparoscopy is available to patients with a BMI of 29.9 or less. This will allow Dr. Monteith and/or Dr. Berger to assess the damage to the tubes prior to proceeding with the the tubal reversal. Since the amount of damage caused by the cautery technique is unknown, this is an excellent sense of “insurance”.
May 18th, 2008 at 7:02 am
This is great information for women who have had their tubes burned. Many times women think that because their tubes have been burned that there is no chance for them to be able to have another baby. It is great to know that there is hope out there for them.
May 17th, 2008 at 7:41 pm
The reviews of various tubal ligation methods that Dr. Monteith has added to the Tubal Reversal Blog are very informative. If doctors who perform tubal ligations read these articles, I think more of them would choose to use tubal clips or bipolar tubal coagulation as the preferred methods of female sterilization. They are very effective in preventing pregnancy. Since many women decide to have another baby after having their tubes tied, these methods are better to use than monopolar tubal coagulation since they have higher pregnancy rates after tubal reversal surgery.