 It is also possible to perform the surgery without a laparoscope, using larger abdominal incisions.It is also possible to perform an interval tubal ligation hysteroscopically, which may be performed under local anesthesia, moderate sedation, or full general anesthesia.While no methods of hysteroscopic sterilization are currently on the market in the United States as of 2019, the Essure and Adiana systems were previously used for hysteroscopic sterilization, and research trials are investigating new hysteroscopic approaches.