According to current regulations for non-hospitalisation surgery, patients undergoing an operation must meet certain personal conditions that will guarantee that a restricted discharge may be feasible in that particular patient’s case.

Those conditions are:

• to be an adult.
• to have legal capacity (subjects legally unable must present a legal warrant).
• to be literate.
• to arrive with, and be accompanied for the 24 hours following the procedure by a responsible adult with no disability and literate.
• guarantees must be given that the patient will understand and take responsibility during the post-operative and will follow the instructions that may be given to her.
• there must be assurance that in the place where the patient is to stay over the 24-48 hours that follow the procedure, no difficulties will arise that may compromise the patient’s safety (environmental, hygienic conditions, accessibility for evacuation if required, means to communicate with qualified medical or nursing staff should any doubt arise post-operatively; a suitable, easily accessible health care centre where any potential complication may be attended, etc.).
• if the patient comes from outside Barcelona, it should be arranged that the patient may stay in town, if required, at least 24 hours. Residents who live far from the centre are advised to make arrangements so that the procedure takes place in the morning. · presentation of the identification card is mandatory.

Selection criteria

No all applicants are suitable for the non-hospitalisation surgery modality, according to current medical and legal criteria.

The following must be taken into account

• The patient should have no other concurrent condition. In the particular case of tubal blockade, the anaesthetics classification should not exceed A.S.A. I or A.S.A. II, although it is better that the anaesthetics unit assuming the risk should determine that.
• The patient should have no background of pelvic inflammatory disease, whether clinical or post-surgical.
• The patient should have no laparotomy wounds in the infraumbilical mid-line.
• The patient should have no large adiposus panniculus either in the meso or the hypogastrium, although it is better that the laparoscopist himself decides on the level of difficulty.

Pre-operative criteria

• The patient must be reasonably sure that she is not pregnant, even though there has been no faults in her menstruation.
• The procedure application, as well as one copy of the procedure informative brochure, must be signed.
• Pre-operatively, a physical examination must be performed, or else written documentation indicating it has been performed must be made available, including a report specifically explaining: "that there is no contraindication for peri-laparoscopic examination to be performed on the patient". A typical pre-operative physical examination for a patient in whom no concurrent condition is suspected should include:
  • Anamnesis, clinical record and obstetrical-gynaecological background.
  • Blood laboratory testing: · Hematocrit, RBC, WBC, haemoglobin, platelets, M.C.V., M.C.H., M.C.H.C., prothrombin rate, partial thromboplastin time, blood group and Rh type. This will be extended when considered necessary.
  • E.C.G. in patients over 35 years, or when cardiocirculatory changes are suspected. Anterolateral chest X-ray in all patients over 35 years, or when cardiocirculatory changes are suspected.
  • Psychosomatic consultation to make sure this is a well-meditated decision, particularly in women under 35 years and with less than two children.

Preparation for the operation

• Patients must carry out an intestinal tract preparation as explained in the enclosure.
• Patients must avoid the ingestion of liquids and solids, as well as smoking, for at least 6 hours prior to the operation.

Surgical methodology

The operation is performed under a very fast elimination anaesthetic combination, without muscle relaxants or major anagelsia, so that the patient may be considered recovered one hour after administration of anaesthesia.

The approach is through surgical optical laparoscopy, entering the abdominal cavity through a one centimetre long peri-intraumbilical incision, following the creation of a pneumoperitoneum of approximately two litres of N2O.

The system used for the blockade of the Fallopian tubes is by application of electrocoagulation with a bipolar forceps in three points of the middle third.

The skin is then closed with a 2/0 silk thread, that should be removed within one week.

The average duration of the procedure is about 12 minutes 30 seconds.

Criteria for restricted discharge

When the patient shows sensorial recovery, a good time-space orientation, the ability for standing and walking and vital constants are within the normal range.

Remarks

A tubal blockade procedure can be done simultaneously to an I.V.E., taking advantage when appropriate of the same act of anaesthesia induction and if all the conditions mentioned above are met.

In the event of a patient in whom the performance of this procedure as ambulatory surgery is contraindicated, the operation may still be accomplished under the same characteristics but with hospitalisation provided the patient accepts the possibility of complications taking place and authorises the type of surgery that may be required to overcome them.