A tubal ligation can be done by an open procedure or laparoscopy. In the open operation the surgeon (usually a gynaecologist) makes a horizontal cut about 7cm. long just above the pubic bone to gain access to the fallopian tubes and then ties or clamps them. The scar should be below the line of all but the briefest of bikinis. The commoner and simpler operation is a laparoscopy. Two small cuts are made in the abdomen, one in the belly button and one low down on one side. Each is 1cm. long. Through these small cuts, long stainless-steel tubes are placed. The surgeon looks through one, and operates with very long, fine instruments through the other.
The Fallopian tubes are closed with metal clips and electrically burnt in this procedure, which takes only 15 minutes under a general or local anaesthetic in a hospital or clinic. Laparoscopy can also be done through a cut in the top of the vagina, which avoids any scars, but is technically more difficult and sex must be avoided for several weeks. Only an overnight stay is required in hospital with these procedures. With laparoscopy there is only minor lower abdominal discomfort for a few days, and normal work can be resumed after a week. Recovery is a little slower with the open operation.If the circumstances are appropriate, and if arranged with theobstetrician beforehand, tubal ligation can be performed at the same time as a Caesarean section.