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HEALTH- Use of Laparoscopy for Sterilisations

DURING 1982-83, 3.98 million female sterilisations were carried out in the country, mostly in mass sterilisation camps. More than 60 per cent of those operations have been performed using the laparoscopic method. Evaluation reports of many of these camps now reveal that post-operative death rates in these camps after laparoscopic sterilisation is an estimated 10-12 per 100,000 operations, although the maximum acceptable risk is acknowledged as being not more than 0.25 to 0.5 per 100,000 operations. The Indian Association of Gynaecological Endoscopists have recently issued a strong statement criticising the way mass sterilisation camps are conducted. The Association, which hosted the Second Asian Congress of Gynaecological Endoscopists in Bombay recently, is concerned about the indiscriminate use of laparoscopy for sterilisation. They feel that this could ultimately lead to the discarding of the procedure itself which could be of great value in India, Laparoscopy involves the use of an instrument which can be introduced into the abdomen through a tiny puncture less than 10/12 mm in length. The instrument is fitted with a 'cold' light (using the technique of fibre optics) and a set of lenses for viewing the organs inside the abdominal cavity. Other specialised instruments can be introduced into the telescope-like rube and operations can be performed without opening up the abdomen. Sterilisation through laparoscopic method is performed by occluding the Fallopian tubes (which convey the mature eggs from the ovary to the uterus) either by using rings or clips, or by cutting and cauterising the tubes. Laparoscopic sterilisation is being used extensively in India and the cumulative experience is perhaps the largest in the world, AIthough laparoscopy was pioneered in West Germany and France its use there is mostlv for diagnosis, and operative procedures other than sterilisation.

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