Bipolar and Monopolar Tubal Coagulation Explained

Coagulation in tubal ligation surgery is a method that cauterizes the tubes, destroying the tissue using an electrical current. Two types of coagulation used to cauterize fallopian tubes are bipolar and monopolar.

Bipolar Tubal Coagulation

Bipolar tubal coagulation is a very popular method of laparoscopic female sterilization in the United States. With this method of tubal ligation, the fallopian tube is grasped between two poles of electrical conducting forceps, and electrical current passes through the tube between the two ends of the forceps. Damage to the tube is limited to the segment between the forceps. Often, two or three adjacent sites are coagulated resulting in loss of approximately 2-5 cm of fallopian tube.

Bipolar tubal coagulation is a good method of female sterilization for women who decide to have a tubal reversal procedure. Pregnancy rates after reversal of this method are approximately 60% but can be much lower if much of the tube has been damaged. Patients having this procedure often choose IVF instead of tubal reversal surgery because of the lower success rate. If multiple sites have undergone coagulation, screening laparoscopy is recommended to evaluate the tubal lengths remaining for repair.

Monopolar Tubal Coagulation

Monopolar coagulation of the fallopian tubes is less common than bipolar coagulation for ligation. The electrical current spreads outward from the coagulating forceps, so monopolar coagulation damages more of the fallopian tube than bipolar coagulation. In most cases, the tube is also cut after it has been coagulated. When a single site of the tube has been coagulated and divided, tubal reversal can be performed without the need for further diagnostic tests. If multiple sites have undergone monopolar coagulation, screening laparoscopy is recommended to evaluate the tubal lengths remaining for repair. Pregnancy rates after reversal of monopolar coagulation procedures are 40-50%.