Surgery

Hysteroscopic Sterilization

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Hysteroscopic Sterilization, Microinsert Nonincisional Hysteroscopic Sterilization

  • Definition
  1. Hysteroscopically-placed device in fallopian tube
  • Indication
  1. Permanent sterilization for women
  • Contraindications
  1. Nickel allergy
  2. Chronic use of Corticosteroids
  • Background
  1. Small coil device (Essure) that expands after placement
  2. Lower adverse effects than Tubal Ligation
  3. Irreversible
  • Technique
  1. Performed by gynecologist using hysteroscopy
  2. Procedure time <15 minutes
    1. Additional 20 minutes of set-up and completion
  3. Placed during Proliferative Phase of Menstrual Cycle
    1. Place at least 2 days prior to anticipated Ovulation
    2. Assists with identifying fallopian tube opening
    3. Lowers risk of pregnancy following insert
  4. May not be possible to place both sides at same time
    1. Return for second side placement in 10-20%
  • Precautions
  1. Not effective until 12 weeks after placement
  2. Needs hysterosalpingogram at 3 months to confirm placed
    1. Ultrasound may be sufficient
  • Adverse Effects
  1. Expulsion of Essure device: 2.9%
  2. Perforation: 1.8%
  3. Mis-placed device: 0.6%
  4. Miscellaneous adverse effects post-procedure
    1. Pelvic Pain
    2. Altered menstrual flow (5%)
    3. Abdominal Pain
    4. Back or Leg Pain
  • References
  1. Welsh (2006) New Contraceptives, Lecture, Wyoming, MN
  2. Cooper (2003) Obstet Gynaecol 102:59-67 [PubMed]