LAPAROSCOPIC TUBAL-LIGATION IN A MINIMALLY INVASIVE SURGICAL UNIT UNDER LOCAL-ANESTHESIA COMPARED TO A CONVENTIONAL OPERATING-ROOM APPROACHUNDER GENERAL-ANESTHESIA

Objective: This study was done to compare costs, operating and recover y times, safety, and patient acceptance between (a) minimally invasive laparoscopic tubal ligation under sedation and local anesthesia and ( Ib) conventional laparoscopic operating-room-based tubal ligations und er general anesthesia. Methods: Fourteen women desiring sterilization were randomized between tubal ligation under sedation/local analgesia versus general anesthesia. Procedures were performed by supervised res idents previously unfamiliar with the minimally invasive technique. Ho spital charges were used as a surrogate for cost. Operating or procedu re room times, surgical complications, and recovery times were recorde d. Patient acceptance was assessed using satisfaction surveys administ ered in the recovery room and again 1 week postoperatively. Results: T he cost of minimally invasive tubal ligation was significantly lower t han for the conventional technique ($1,615 +/- $134 vs $2,820 +/- $110 , p < 0.001). Surgical times were not different between the two proced ures: 40.4 +/- 15 min for the conventional technique versus 32.9 +/- 1 0 min for minimally invasive surgery. However, the total in-room time required in the operating room significantly exceeded that for the pro cedure room technique (84 +/- 10 min vs 60 +/- 2 min, p < 0.05). Likew ise, recovery time for the general anesthesia technique was longer (48 +/- 6 min vs 14 +/- 7 min, p < 0.03). No complications were encounter ed with either surgical method. Patient satisfaction for pain, fatigue , and days of missed work was similar between the two groups. Conclusi ons: The use of minimally invasive surgery to perform tubal ligation i s advantageous over conventional laparoscopic tubal ligation under gen eral anesthesia with regard to cost and time utilization. The minimall y invasive technique appears to be easy to learn, safe, and well toler ated.