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Young K, Mou T, Geynisman-Tan J, Tavathia M, Collins S, Mueller M, Lewicky-Gaupp C, Kenton K. Truth or Myth: Intra-abdominal Pressure Increases in the Lithotomy Position. J Minim Invasive Gynecol 2020; 28:26-29. [PMID: 32229258 DOI: 10.1016/j.jmig.2020.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/09/2020] [Accepted: 03/14/2020] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE To determine if there were differences in intra-abdominal pressure (IAP) in the supine, low lithotomy, and high lithotomy positions. DESIGN Prospective cohort study. SETTING University medical center. PATIENTS Twenty-nine women undergoing surgery for prolapse or stress incontinence. INTERVENTIONS Relevant medical history, including the pelvic organ prolapse quantification stage, body mass index, and airway grade (Mallampati score), was abstracted from patients' medical charts. IAP was measured in centimeters of water (cmH2O) on the day of their surgery before induction of general or intravenous anesthesia using a T-doc air charged urodynamic catheter (Laborie Aquarius; Ontario, Canada) placed in a patient's vagina (for patients with incontinence) or rectum (for patients with prolapse). MEASUREMENTS AND MAIN RESULTS IAP was measured in 3 positions: supine (legs at 0°), low lithotomy (legs in Yellowfin stirrups at 45°; Allen Medical, Acton, MA), and high lithotomy (legs at 90°). The means ± SDs IAP for the groups were as follows: in the supine position, 18.6 cmH2O ± 7.6; low lithotomy, 17.7 cmH2O ± 6.6; and high lithotomy, 17.1 cmH2O ± 6.3. In the same women, there was a significant decrease in IAP from the supine to high lithotomy positions, with a mean difference of 1.4 cmH2O ± 3.7, p = .05. Similarly, there was a significant, though smaller, decrease in mean IAP when moving from the supine to low lithotomy positions in these same women (mean decrease of 0.9 cmH2O ± 1.5, p = .004). Neither change is clinically significant based on previous research that suggests 5 cmH2O is a clinically significant change. CONCLUSION Placing patients' legs in a low or high lithotomy position does not result in a clinically significant increase in IAP. Therefore, surgeons and anesthesiologists can consider positioning patients' lower extremities in stirrups while patients are awake to minimize discomfort and possibly reduce the risk of nerve injuries.
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Affiliation(s)
- Karen Young
- Northwestern Prentice Women's Hospital, and Northwestern University Feinberg School of Medicine (Ms. Young), Chicago, Illinois
| | - Tsung Mou
- Division of Female Pelvic Medicine and Reconstructive Surgery (Drs. Mou, Geynisman-Tan, Collins, Mueller, Lewicky-Gaupp, and Kenton, and Ms. Tavathia)
| | - Julia Geynisman-Tan
- Division of Female Pelvic Medicine and Reconstructive Surgery (Drs. Mou, Geynisman-Tan, Collins, Mueller, Lewicky-Gaupp, and Kenton, and Ms. Tavathia).
| | - Meera Tavathia
- Division of Female Pelvic Medicine and Reconstructive Surgery (Drs. Mou, Geynisman-Tan, Collins, Mueller, Lewicky-Gaupp, and Kenton, and Ms. Tavathia)
| | - Sarah Collins
- Division of Female Pelvic Medicine and Reconstructive Surgery (Drs. Mou, Geynisman-Tan, Collins, Mueller, Lewicky-Gaupp, and Kenton, and Ms. Tavathia)
| | - Margaret Mueller
- Division of Female Pelvic Medicine and Reconstructive Surgery (Drs. Mou, Geynisman-Tan, Collins, Mueller, Lewicky-Gaupp, and Kenton, and Ms. Tavathia)
| | - Christina Lewicky-Gaupp
- Division of Female Pelvic Medicine and Reconstructive Surgery (Drs. Mou, Geynisman-Tan, Collins, Mueller, Lewicky-Gaupp, and Kenton, and Ms. Tavathia)
| | - Kimberly Kenton
- Division of Female Pelvic Medicine and Reconstructive Surgery (Drs. Mou, Geynisman-Tan, Collins, Mueller, Lewicky-Gaupp, and Kenton, and Ms. Tavathia)
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Current techniques and outcomes in hysteroscopic sterilization: current evidence, considerations, and complications with hysteroscopic sterilization micro inserts. Curr Opin Obstet Gynecol 2017; 29:218-224. [PMID: 28537948 DOI: 10.1097/gco.0000000000000369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW To describe the current data regarding effectiveness, complications, postoperative evaluation, and surgical interventions associated with Essure hysteroscopic sterilization. RECENT FINDINGS Hysteroscopic sterilization is a commonly performed procedure that is offered as a well tolerated, effective, outpatient method of permanent sterilization. Over the past several years, concerns have been raised regarding correct placement and postoperative complications. This has led to statements by both the Food and Drug Administration (FDA) in October, 2016 and American Association of Gynecologic Laparoscopists in February, 2017, as a significant portion of women seek removal of these devices. A current black-box warning issued by the FDA in 2016 recommends discussion of 'the probabilities of rates or events' of adverse outcomes associated with Essure placement. SUMMARY Although hysteroscopic sterilization is usually a safe, effective option for permanent contraception, new evidence regarding complications has emphasized the need for proper education and counseling. Appropriate patient selection and knowledge of potential complications is paramount to ensuring patients, and medical providers are well informed and have realistic expectations regarding potential placement and postoperative issues.
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Frietze G, Leyser-Whalen O, Rahman M, Rouhani M, Berenson AB. A Meta-Analysis of Bilateral Essure ® Procedural Placement Success Rates on First Attempt. J Gynecol Surg 2015; 31:308-317. [PMID: 26633935 DOI: 10.1089/gyn.2015.0054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The Essure® (Bayer HealthCare Pharmaceuticals, Leverkusen, Germany) female sterilization procedure entails using a hysteroscope to guide a microinsert into the Fallopian tube openings. Failed placement can lead to patient dissatisfaction, repeat procedures, unintended or ectopic pregnancy, perforation of internal organs, or need for subsequent medical interventions. Additional interventions increase women's health risks, and costs for patients and the health care industry. Demonstrated successful placement rates are 63%-100%. To date, there have not been any systematic analyses of variables associated with placement rates. Objectives: The aims of this review were: (1) to estimate the average rate of successful bilateral Essure microinsert placement on first attempt; and (2) to identify variables associated with successful placement. Materials and Methods: A meta-analysis was conducted on 64 published studies and 19 variables. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, all published studies between November 2001 and February 2015 were reviewed. The studies were taken from from PubMed and Google Scholar, and by using the the "snowball" method that reported variables associated with successful bilateral Essure placement rates. Results: The weighted average rate of successful bilateral microinsert placement on first attempt was 92% (0.92 [95% confidence interval: 0.904-0.931]). Variables associated with successful placements were: (1) newer device models; (2) higher body mass index; and (3) a higher percent of patients who received local anesthesia. Conclusions: The data gathered for this review indicate that the highest bilateral success rates may be obtained by utilizing the newest Essure device model with local anesthesia in heavier patients. More standardized data reporting in published Essure studies is recommended. (J GYNECOL SURG 31:308).
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Affiliation(s)
- Gabriel Frietze
- Department of Psychology, The University of Texas at El Paso , El Paso, TX
| | - Ophra Leyser-Whalen
- Department of Sociology and Anthropology, The University of Texas at El Paso , El Paso, TX
| | - Mahbubur Rahman
- Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch , Galveston, TX
| | - Mahta Rouhani
- Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch , Galveston, TX
| | - Abbey B Berenson
- Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch , Galveston, TX
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Moureau D, Laurent N, Rubod C, Lucot JP, Salleron J, Faye N. Evaluation of tubal microinserts position using 3D ultrasound and pelvic X-ray. Diagn Interv Imaging 2015; 96:1133-40. [PMID: 26163222 DOI: 10.1016/j.diii.2014.12.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 04/30/2014] [Accepted: 12/03/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE To retrospectively compare three-dimensional ultrasonography (3D-US) and pelvic X-rays to assess the position of tubal sterilization microinserts. MATERIAL AND METHODS Forty-four patients who underwent tubal sterilization with Essure(®) microinserts in our institution were included. The microinserts'position was evaluated three months after the procedure using 3D-US and pelvic X-rays. Placement on 3D-US was binary categorized as correct or incorrect and the distance between the two devices was reported. The orientation and symmetric deployment of the microinserts and the distance between the proximal parts of the two devices was assessed on pelvic X-rays. Performance of 3D-US and pelvic X-ray were compared using Mac Nemar test. Comparison of the distance between the two devices measured on pelvic X-rays and 3D-US was made with the paired Student t test. RESULTS 3D-US images showed microinserts in 93% (41/44). Eighty-six percent (38/44) were correctly positioned on 3D-US and 82% (36/44) on pelvic X-rays. No significant differences between the performances of the two imaging techniques were found. No significant differences for the distance between the two devices measured on pelvic X-ray and 3D-US was found. CONCLUSION 3D-US is a simple, non-ionizing technique, which appears as a promising alternate technique to pelvic X-rays to assess the correct position of Essure(®) microinserts.
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Affiliation(s)
- D Moureau
- Women Medical Imaging Department, Jeanne-de-Flandre Hospital, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille, France.
| | - N Laurent
- Women Medical Imaging Department, Valenciennes Hospital, Lille Nord University, Valenciennes, France
| | - C Rubod
- Gynecology Department, Jeanne-de-Flandre Hospital, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille, France
| | - J P Lucot
- Gynecology Department, Jeanne-de-Flandre Hospital, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille, France
| | - J Salleron
- Department of Biostatistics, EA2694, UDSL, Lille University, Lille, France
| | - N Faye
- Women Medical Imaging Department, Jeanne-de-Flandre Hospital, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille, France
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la Chapelle CF, Veersema S, Brölmann HA, Jansen FW. Effectiveness and feasibility of hysteroscopic sterilization techniques: a systematic review and meta-analysis. Fertil Steril 2015; 103:1516-25.e1-3. [DOI: 10.1016/j.fertnstert.2015.03.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 03/12/2015] [Accepted: 03/12/2015] [Indexed: 10/23/2022]
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Ouzounelli M, Reaven NL. Essure Hysteroscopic Sterilization Versus Interval Laparoscopic Bilateral Tubal Ligation: A Comparative Effectiveness Review. J Minim Invasive Gynecol 2015; 22:342-52. [DOI: 10.1016/j.jmig.2014.12.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 11/18/2014] [Accepted: 12/02/2014] [Indexed: 12/01/2022]
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Bougie O, Wang V, Lortie K, Shenassa H, Singh SS. High Patient Satisfaction with Office Hysteroscopy Using Tailored Analgesia Protocols. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2013.0067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Olga Bougie
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Obstetrics, Gynecology, and Newborn Care, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Vivian Wang
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Karine Lortie
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Obstetrics, Gynecology, and Newborn Care, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Hassan Shenassa
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Obstetrics, Gynecology, and Newborn Care, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sukhbir S. Singh
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Obstetrics, Gynecology, and Newborn Care, The Ottawa Hospital, Ottawa, Ontario, Canada
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Wortman M, Daggett A, Ball C. Operative Hysteroscopy in an Office-Based Surgical Setting: Review of Patient Safety and Satisfaction in 414 Cases. J Minim Invasive Gynecol 2013; 20:56-63. [DOI: 10.1016/j.jmig.2012.08.778] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 08/20/2012] [Accepted: 08/23/2012] [Indexed: 10/27/2022]
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Wald RM, Sermer M, Colman JM. Pregnancy and contraception in young women with congenital heart disease: General considerations. Paediatr Child Health 2012; 16:e25-9. [PMID: 22468131 DOI: 10.1093/pch/16.4.e25] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2010] [Indexed: 11/13/2022] Open
Abstract
Young women with heart disease are increasingly being seen in obstetrical referral centres owing, in large part, to the dramatic improvements in survival of young adults with congenital heart disease in recent years. Although pregnancies in most women with heart disease result in favourable outcomes, there are important exceptions that must be recognized. These exceptions pose significant mortality risk to the mother and/or the fetus. The present article outlines cardiovascular adaptations to pregnancy, general outcomes and management considerations for practitioners caring for pregnant young women with congenital heart disease. A lesion-specific review is published in a complementary article.
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Affiliation(s)
- Rachel M Wald
- Toronto General Hospital, Mount Sinai Hospital and Toronto Congenital Cardiac Centre for Adults, University Health Network
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Isley MM, Jensen JT, Nichols MD, Lehman A, Bednarek P, Edelman A. Intrauterine lidocaine infusion for pain management during outpatient transcervical tubal sterilization: a randomized controlled trial. Contraception 2012; 85:275-81. [DOI: 10.1016/j.contraception.2011.06.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 06/30/2011] [Indexed: 10/17/2022]
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Leyser-Whalen O, Rouhani M, Rahman M, Berenson AB. Tubal risk markers for failure to place transcervical sterilization coils. Contraception 2011; 85:384-8. [PMID: 22036044 DOI: 10.1016/j.contraception.2011.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 09/07/2011] [Accepted: 09/08/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND There is a growing body of literature on placement rates of the Essure® procedure, yet prior studies have not attempted to identify tubal-associated risk factors for placement failures. The current study examines risk markers associated with the inability to deploy the Essure® coils into the tubal lumen using the new ESS305 design. STUDY DESIGN We used electronic medical record data to assess risk markers associated with the inability to place the Essure coils in the tubal lumen using the new ESS305 design. A total of 310 attempted procedures between June 14, 2007, and April 29, 2011, were analyzed. RESULTS There were 18 tubal failures (5.8%) out of the 310 attempted procedures. A history of a prior sexually transmitted infection (STI) was associated with tubal failure (odds ratio 2.64, 95% confidence interval 1.01-6.90, p=.048). CONCLUSIONS We speculate that the observed association between a prior STI and an inability to place the coil was due to a past history of pelvic inflammatory disease.
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Affiliation(s)
- Ophra Leyser-Whalen
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX 77555, USA
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Serfaty D. Stérilisation. Contraception 2011. [DOI: 10.1016/b978-2-294-70921-0.00016-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Thiel JA, Lukwinski A, Kamencic H, Lim H. Oral Analgesia vs Intravenous Conscious Sedation during Essure Micro-Insert Sterilization Procedure: Randomized, Double-Blind, Controlled Trial. J Minim Invasive Gynecol 2011; 18:108-11. [DOI: 10.1016/j.jmig.2010.10.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 10/12/2010] [Accepted: 10/14/2010] [Indexed: 11/24/2022]
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Wortman M. Instituting an Office-Based Surgery Program in the Gynecologist’s Office. J Minim Invasive Gynecol 2010; 17:673-83. [DOI: 10.1016/j.jmig.2010.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 06/14/2010] [Accepted: 07/02/2010] [Indexed: 11/27/2022]
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Cicinelli E. Hysteroscopy without anesthesia: review of recent literature. J Minim Invasive Gynecol 2010; 17:703-8. [PMID: 20955981 DOI: 10.1016/j.jmig.2010.07.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 07/03/2010] [Indexed: 10/18/2022]
Abstract
The need for anesthesia or analgesia for performing hysteroscopy is still matter of debate. Many factors explain the lack of agreement about anesthesia in hysteroscopy depending on the instrumentation, technique employed, need of performing surgical procedure, operator skill and patients' characteristics. Diagnostic minihysteroscopy (3.5 mm or less in size) is less painful and easier to perform than hysteroscopy performed with instruments sized around 5 mm. Thanks to miniaturized instruments, office hysteroscopy allows a growing number of women to be treated in an office setting avoiding the operating room. The main limitation to its widespread use is pain and low patient tolerance. Intrauterine surgical procedures involving only the endometrial mucosa (biopsies, adhesiolisis, cervical and endometrial polyectomies) are not painful. For endometrial polypectomy size of polyps (<2.2m) and duration of the procedure (more than 15 min) are limiting factors. Most literature suggests that office hysteroscopy in experienced hands is a well-tolerated technique and requires the use of analgesics only in selected patients like women with previous caesarean section, history of chronic pelvic pain, anxiety and in menopause.
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Affiliation(s)
- Ettore Cicinelli
- Fourth Department of Obstetrics and Gynecology, Faculty of Medicine, University of Bari, Bari, Italy.
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Analysis of pain and satisfaction with office-based hysteroscopic sterilization. Fertil Steril 2010; 94:1189-1194. [DOI: 10.1016/j.fertnstert.2009.07.994] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Revised: 07/02/2009] [Accepted: 07/14/2009] [Indexed: 10/20/2022]
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Ploteau S, Lopes P. Pregnancy after hysteroscopic tubal sterilization despite two hysterosalpingograms showing bilateral occlusion. Eur J Obstet Gynecol Reprod Biol 2009; 147:238-9. [DOI: 10.1016/j.ejogrb.2009.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Revised: 06/25/2009] [Accepted: 08/10/2009] [Indexed: 11/26/2022]
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Bigolin S, Fagundes DJ, Rivoire HC, Fagundes ATN, Fagundes ALN. Transcervical hysteroscopic sterilization using cyanoacrylate: A long-term experimental study on sheep. J Obstet Gynaecol Res 2009; 35:1012-8. [DOI: 10.1111/j.1447-0756.2009.01075.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ploteau S, Haudebourg M, Philippe HJ, Lopes P. Stérilisation tubaire par voie hystéroscopique chez les femmes de plus de quarante ans : quelle motivation pour ces femmes ? ACTA ACUST UNITED AC 2009; 37:775-9. [DOI: 10.1016/j.gyobfe.2009.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Accepted: 08/12/2009] [Indexed: 12/01/2022]
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