Laparoscopic tubal ligation in a minimally invasive surgical unit under local anesthesia compared to a conventional operating room approach under general anesthesia

Objective: This study was done to compare costs, operating and recovery 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 under general anesthesia. Methods: Fourteen women desiring sterilization were randomized between tubal ligation under sedation/local analgesia versus general anesthesia. Procedures were performed by supervised residents previously unfamiliar with the minimally invasive technique. Hospital charges were used as a surrogate for cost. Operating or procedure room times, surgical complications, and recovery times were recorded. Patient acceptance was assessed using satisfaction surveys administered in the recovery room and again 1 week postoperatively. Results: The cost of minimally invasive tubal ligation was significantly lower than for the conventional technique ($1,615 +/- $134 vs $2,820 +/- $110, p < 0.001). Surgical times were not different between the two procedures: 40.4 +/- 15 min for the conventional technique versus 32.9 +/- 10 min for minimally invasive surgery. However, the total in-room time required in the operating room significantly exceeded that for the procedure room technique (84 +/- 10 min vs 60 +/- 2 min, p < 0.05). Likewise, recovery time for the general anesthesia technique was longer (48 +/- 6 min vs 14 +/- 7 min, p < 0.03). No complications were encountered with either surgical method. Patient satisfaction for pain, fatigue, and days of missed work was similar between the two groups. Conclusions: The use of minimally invasive surgery to perform tubal ligation is advantageous over conventional laparoscopic tubal ligation under general anesthesia with regard to cost and time utilization. The minimally invasive technique appears to be easy to learn, safe, and well tolerated.