Hysteroscopic sterilization with Essure® device in situ: a challenge?

Abstract

Hysteroscopic sterilization through the Essure® method is preferably performed in the outpatient department without any form of anesthesia. This approach requires the hysteroscopic skills of the gynecologist to use the vaginoscopic route. Initially, the manufacturer advised to remove any type of intrauterine device (IUD), 1 month before the procedure, to prevent difficult procedures and also to increase the success rate of placement. This observational prospective study analyzed the outcome in women in where the IUD was left in the uterus during the sterilization. During a period of 2 years, all women have been included consecutively in seven public hospitals located in France and the Netherlands. During this procedure, 32 out of 239 IUDs had to be removed to finish the sterilization successfully. The placement success rate was 97%. Placement failures were not related to the IUD being present at the time of the procedure. At confirmation tests 3 months after insertion of the Essure®, only five tubes were still patent. No complications were registered. Pain was recorded, and women responded well on oral nonsteroidal anti-inflammatory drug medication. The IUD did not need to be removed before the start of the hysteroscopic sterilization; only in case the procedure could not be completed, the IUD had to be removed during the sterilization itself. Placement rate was 97.1%.

Tubal risk markers for failure to place transcervical sterilization coils

“…Furthermore, few data are available on placement rates among women at risk for tubal disease as they are often excluded from the studies. In addition, few data are available on placement rates using the new ESS305 design, third-generation model which was approved for use in the US in June 2007 [24,28,32,36]. The current study adds to the literature by examining risk markers associated with the inability to deploy the Essure® coils into the tubal lumen using the new ESS305 design, third-generation model.…”

Contraception permanente par pose hystéroscopique d’implants tubaires

“…Aucun auteur ne rapporte de complication spécifique notamment au moment de l'ablation du stérilet. Pour autant, il s'agit de courtes séries à partir desquelles il ne faudrait pas prendre de décision trop hâtives [20][21][22]. L'autre point clé concernant ces patientes concerne la disparition du bénéfice spécifique du système intra-utérin au lévonorgestrel.…”

A Meta-Analysis of Bilateral Essure® Procedural Placement Success Rates on First Attempt

“…Several studies included unilateral placement rates in women who had previous salpingectomies, 13,22,48 so these placement rates were omitted from the total denominators and numerators as necessary. Eight articles 9,10,17,19,25,26,30,56 only reported bilateral placement rates after more than one attempt. In these cases, the placement rate was recalculated using the data supplied in the article for the first attempt.…”