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.