Development of a novel method of female sterilization: II. Retention of tubal screws in patients undergoing simultaneous laparoscopic sterilization

Currently available devices for female sterilization

Sterilization is now the method of family planning most commonly used in the world. Over the last 150 years, research has evolved in the search for the ideal method of female sterilization. The procedure should ideally have high efficacy, be readily accessible and be personally and culturally acceptable. The method should be simple, quick, easily learned and be able to be performed in an outpatient setting without general anesthesia. The most common and effective method for sterilization has, thus far, been via the laparoscopic route. Hysteroscopic sterilization, however, potentially fulfills many of these ideal criteria, but until recently has remained more of a concept than a reality.

Hysteroscopic sterilization in women with severe cardiac disease: experience at a tertiary center

OBJECTIVE

To determine the feasibility and effectiveness of hysteroscopic sterilization as a minimally invasive sterilization method for women with high-risk cardiac disease.

PARTICIPANTS AND METHODS

In a retrospective cohort study, 18 women with high-risk cardiac conditions that strictly contraindicated pregnancy were compared with a reference cohort of 157 women without cardiac disease. All underwent microinsert hysteroscopic sterilization at Mayo Clinic from January 2003 through February 2007. End points included successful placement, fallopian tube patency determined by hysterosalpingogram 3 months after the procedure, and pregnancy status.

RESULTS

Women in the cardiac cohort were younger than those in the reference cohort (median age, 25 vs 39 years; P<.001), had lower parity (median, 0 vs 2; P<.001), and had a higher proportion of patients categorized as American Society of Anesthesiologists' physical status 3 (severe systemic disease) and physical status 4 (systemic disease that is a constant threat to life) (83% vs 6%; P<.001). No significant differences were noted for use of general anesthesia (17% vs 27%; P=.41), successful bilateral device placement (100% vs 95%; P>.99), postoperative pain score (median, 0 for both groups; P=.87), or length of hospitalization (median, 6 vs 6 hours; P=.63). No intraoperative complications occurred. Follow-up hysterosalpingography showed high tubal occlusion rates in both cohorts (100% cardiac; 98% reference; P>.99). No pregnancies occurred during a median follow-up period of 20 months (interquartile range, 8-33 months).

CONCLUSION

For women with cardiac disease and strict contraindications for pregnancy, microinsert hysteroscopic sterilization provided minimally invasive, permanent, and reliable contraception.

Sonography, CT, and MRI appearance of the Essure microinsert permanent birth control device

OBJECTIVE

The purpose of this article is to describe the appearance and location of the Essure permanent birth control device on sonography, CT, and MRI.

CONCLUSION

The Essure device has a distinct appearance and typical location that allow it to be accurately identified on sonography, CT, and MRI scans.

Placement of the Essure Permanent Birth Control Device with Fluoroscopic Guidance: A Novel Method for Tubal Sterilization

An effective transcervical method for fluoroscopically guided fallopian tube occlusion has long been sought for female sterilization. The Essure permanent birth control device was approved by the Food and Drug Administration in November 2002 and is currently indicated for hysteroscopic placement. In a series of eight patients, bilateral Essure microcoils were placed with fluoroscopic guidance in seven patients for a success rate of 87.5%. One patient described peri- and postprocedure pelvic pain, otherwise no complications were identified. All patients returned to normal activities within 24 hours. Fluoroscopically guided transcervical tubal sterilization with the Essure microcoil device (Conceptus, San Carlos, CA) is a viable outpatient procedure.

Hysteroscopic tubal sterilization

This article provides an overview of the history of hysteroscopic sterilization including the current state of the art and future ideals. Unlike laparoscopic techniques, sterilization by hysteroscopy can be performed in an outpatient setting without general anesthesia. Many attempts have been made to develop a safe and effective method, but until recently, without success. The Essure system is the first one that seems to be a realistic alternative to laparoscopic sterilization, but is irreversible. The search is still on for the optimum method of hysteroscopic sterilization.