Adaptation of the Filshie clip applicator port to carry 5-mm instruments without gas escape. A useful technique when unexpected pathology is encountered at laparoscopic sterilization

Introduction Incidental findings of pelvic pathology at the time of laparos copic sterilization are not uncommon, and may necessitate additional instru mentation through a 5-mm port. We describe a simple and inexpensive method of adapting the Filshie clip applicator port to carry 5-mm instruments with out losing gas pressure. When 5-mm instrumentation is required, the instrum ent is placed within the digit of a sterile glove and then inserted through the 7.5-mm Filshie clip applicator port. The glove digit remains within th e port preventing gas escape whilst the instrument punctures the tip to eme rge through the port to be used in the normal way. Results We report the results of a prospective study of 50 consecutive lapa roscopies. Ease of use, gas leakage rates and complications are recorded. H aving demonstrated the effectiveness of this technique, we evaluated its us efulness, by performing a retrospective case review of the operating notes of 50 consecutive laparoscopic sterilizations, recording the incidence of d ocumented pelvic pathology and instrument use. Unexpected pathology was enc ountered in 13 cases (26%), and instruments were required in five (10%). Conclusions Incidental abnormalities within the pelvis are not uncommonly e ncountered at laparoscopic sterilization. Where instrumentation is required , our method allows utilization of the Filshie clip applicator port as an a lternative to using a new 5-mm port. The system is cheap, safe and effectiv e. One glove can provide digits for five separate insertions if necessary. We have found this temporary laparoscopic port-reducing method to be a simp le and useful technique which meets the unexpected short-term need for inst rument use at the time of laparoscopic sterilization.