An exclusive production by the Sarawak General Hospital O&G Department on how to perform the Bilateral Tubal Ligation or BTL.
- Before operations: confirm patient’s last menstrual period, exclude pregnancy and take necessary consents
- Ensure the OT check list board is properly filled and empty urinary bladder with in out catheter.
- After proper gowning and scrubbing, the operative area is cleaned and draped.
- Determine the incision site and size – 2 fingers from the symphysis pubis superiorly.
- Make the skin incision about 3 to 4 cm long.
- Open the abdomen in layers until the rectus sheath.
- Open the rectus sheath using the scissors and push the muscle laterally.
- Proceed to open the peritoneal cavity with two artery forcep and the maximburm scissors.
- By using 2 fingers – identify the uterine body and move laterally to identify the fallopian tube.
- Grasps the tube using the babcock. The tube can be determined by identifying the fimbriae end of the tube.
- Lift the tube gently and clamp the area for incision using the artery forceps.
- Make a knot on one side and subsequently on the opposite site. Be sure to relief the artery forceps temporally when making the knot.
- Any absorbable suture size 2/0 can be used – eg. Ecosord, Vicryl or catgut
- The tube can then be excised using the scissors.
- The stump is then inspected for any residual bleeding.
- The same procedure is employed for the contralateral tube.
- Secure any bleeding on the muscle, rectus as well as the fat layer.
- Identify the rectus sheath at its angle and grasp with the artery forceps. Then start closing the rectus using any absorbable suture size 1 – eg. the vicryl or ecosorb.
- Finally close the skin by the subcuticular technique using any absorbable suture – eg. monosyn 3/0