LAPAROSCOPIC POMEROY TUBAL-LIGATION IN A RESIDENCY TRAINING-PROGRAM

Study Objective. To evaluate the efficacy of the laparoscopic Pomeroy method of tubal ligation as a teaching fool during the initial acquisi tion of advanced laparoscopic skills by 14 residents in a 28-person, 4 -year program. Design. A prospective, nonrandomized study. Setting. A metropolitan teaching hospital. Patients, Fifty-seven women who desire d permanent sterilization, and 56 controls who underwent laparoscopic sterilization by standard coagulation. One refused entry and had stand ard sterilization by bipolar coagulation. In two women, both with seve ral previous laparotomies, visualization of the pelvic organs was inco mplete and the procedure was abandoned at the discretion of the surgeo n. One had a minilaparotomy Pomeroy tubal ligation and the other was s terilized by standard two-puncture laparoscopic coagulation. One patie nt was excluded due to an incomplete data profile. Interventions. Lapa roscopic sterilizations using the Pomeroy technique and standard coagu lation were performed by gynecology residents with an attending physic ian present. First-year residents performed 36 (68%) of the 53 procedu res. Measurements and Main Results. Operative times to teach this tech nique to house officers rotating on the gynecologic service were recor ded by postgraduate year and stratified by the number of cases perform ed by each operator. The average operative times for residents in post gradute years 1 through 4 were 18.6, 15.4, 21.7, and 14.8 minutes, res pectively. These diminished with experience. A statistically longer ti me of 7.1 minutes was required to teach residents the Pomeroy techniqu e compared with standard bipolar coagulation (p < 0.0003). Conclusion. Laparoscopic Pomeroy tubal ligation as a method to begin educating re sidents in advanced operative video-laparoscopy appears to have great potential.