Tubal ligation or tubectomy (also known as having one’s “tubes tied”) is a surgical procedure for sterilization in which a woman’s fallopian tubes are clamped and blocked or severed and sealed, either of which prevents eggs from reaching the uterus for implantation. Tubal ligation is considered a permanent method of sterilization and birth control. Procedure Tubal ligation (incorrectly referred to as tubectomy) is considered major surgery, typically requiring the patient to undergo local, general, or spinal anesthesia. It is advised that women should not undergo this surgery if they currently have or had a history of bladder cancer. After the anesthesia takes effect, a surgeon will make a small incision at each side of, but just below the navel in order to gain access to each of the two fallopian tubes. With traditional tubal ligation, the surgeon severs the tubes, and then ties (ligates) them off thereby preventing the travel of eggs to the uterus. Other methods include using clips or rings to clamp them shut, or severing and cauterizingthem. Tubal ligation is usually done in a hospital operating-room setting. Tubal ligation methods Bipolar coagulation The most popular method of laparoscopic female sterilization, this method uses electric current to cauterize sections of the fallopian tube. Monopolar coagulation Less common than bipolar coagulation, monopolar coagulation uses electric current to cauterize the tube together, but also allows radiating current to further damage the tubes as it spreads from the coagulation site. Many cases involve a cutting of the tubes after the procedure. Fimbriectomy By removing a portion of the fallopian tube closest to the ovary, fimbriectomy eliminates the fallopian tube’s ability to capture eggs and transfer them to the uterus. Irving’s procedure This procedure calls for placing two ligatures (sutures) around the fallopian tube and removing the segment of tubing between the ligatures. Then to complete the procedure, the ends of the fallopian tubes are connected to the back of the uterus and the connective tissue respectively.This method was pioneered by the merican Obstetrician-Surgeon, Frederick Carpenter Irving (1883–1957) in 1924. Tubal clip The tubal clip (Filshie clip or Hulka clip) technique involves the application of a permanent clip onto the fallopian tube. Once applied and fastened, the clip disallows movement of eggs from the ovary to the uterus. Tubal ring The silastic band or tubal ring method involves a doubling over of the fallopian tubes and application of a silastic band to the tube. Pomeroy tubal ligation In this method of tubal ligation, a loop of tube is “strangled” with a suture. Usually, the loop is cut and the ends cauterized or “burned“. This type of tubal ligation is often referred to as cut, tied, and burned. This method was develop by the American Gynecologist and Surgeon, Ralph Hayward Pomeroy. Essure tubal ligation In this method of tubal ligation, two small metal and fiber coils are placed in the fallopian tubes. After insertion, scar tissue forms around the coils, blocking off the fallopian tubes and preventing sperm from reaching the egg. Adiana tubal ligation In this method of tubal ligation, two small silicone pieces were placed in the fallopian tubes. During the procedure, the health care provider heated a small portion of each fallopian tube and then inserted a tiny piece of silicone into each tube. After the procedure, scar tissue formed around the silicone inserts, blocking off the fallopian tubes and preventing sperm from reaching the egg. The procedure can no longer be performed due to a lawsuit and judgment brought by the company responsible for Essure.