TUBAL LIGATION.

Although laparoscopic sterilization techniques have become quite popular, many women still request traditional postpartum tubal ligation via minilaparotomy. Most gynecologists learn this fairly simple procedure early in their training, and most of us don't give it much thought. But sometimes it's the simple procedures that end up going bad.

Have you ever noticed that the word ligation sounds a lot like litigation? Here are some pearls that just might keep your next postpartum tubal ligation from turning into tubal litigation.

* Quit while you're ahead.

When the fallopian tube is elevated to the level of the umbilicus and then pulled up out of the patient's body, it is necessarily under some degree of stretch. It's a good idea to always keep that fact in mind during the operation.

In most techniques the ligature or ligatures that are placed around the tube are free ties rather than sutures anchored to tissue with a needle. This is fine as long as you don't play around with the tube after it has been transected. With the free tie in place, it is unlikely that any significant bleeding will occur from small vessels in the tubal pedicle. But if one fiddles around looking for microscopic oozing, the free tie may loosen, causing immediate or delayed hemorrhage.

The lesson is, as Tommy warned Nicole at the end of F. Scott Fitzgerald's "Tender Is the Night," "Let well enough alone."

* Enlighten the scrub nurse.