Uterine manipulation with plastic suction curette at combined abortion and
sterilization
A.K. Banerjee, J.O. Emembolu
Department of Obstetrics and Gynaecology, Leicester Royal Infirmary, UK
Objective: To determine the efficacy and safety of a plastic suction
curette as uterine manipulator during combined surgical abortion and
laparoscopic sterilization.
Design: A six- year prospective observational study in a university
hospital & a district hospital, fertility control and reproductive health
unit.
Method: Plastic suction curettes of sizes between 7mm and 12mm(Synevac
vacuum Curette, Berkeley Mdevices, Inc; California or Curette rigid straight,
Luneau Gynecologie; France) were used for surgical abortion up to 13 weeks in
the day care surgical unit. The curette was also used to manipulate the uterus
and demonstrate the tubes for laparoscopic sterilization. Thereafter, routine
inspection of the pelvic organs was undertaken to exclude any pathology or
iatrogenic damage. Further suction was performed to ensure that the uterus was
empty. Following this a bimanual examination confirmed it to be firm and
haemostasis secured.
Results: Between 1st January 1996 and 31st December 2002, a total of
510 laparoscopic sterilizations were performed together with surgical abortion.
No uterine perforation occurred in this series. Adequate visualization of pelvic
structures was achieved. Minimal intra-operative uterine bleeding was noted as
continued low suction maintained uterine tonicity. No patient required
hospitalization or re-admission for complications of the operation.
Conclusion: This is the first report of the use of plastic suction
curette as Uterine manipulator for laparoscopic sterilisation following surgical
abortion. This study shows that it is a safe, efficient and technically
satisfactory manipulator of a gravid uterus during the first trimester abortion.
Maintenance of suction avoids uterine atony and minimizes intra-operative blood
loss. The curette is disposable, therefore reduces any risk of hospital
cross-infection and also it is cost saving as no additional instrumentation is
required.
